Analysis Of The Efficacy Of Peroral Endoscopic Myotomy In The Treatment Of Achalasia Cardia

Objective:The aim of this study was to analyze the effect of peroral endoscopic myotomy(POEM)in the treatment of achalasia of the cardia and to evaluate symptomatic reflux,weight change,and recurrence.Methods:Patients with achalasia of the cardia treated with POEM at the Department of Gastroenterology of the First Affiliated Hospital of Xinjiang Medical University from November 2014 to January 2023 were included and followed up regularly from 3 months to 5 years,and relevant clinical case data were collected and analyzed for preoperative and postoperative BMI,Eckardt score,and Gerd Q score.Results:According to the time of assessment,6 months after surgery was defined as short-term and 3 years after surgery was defined as long-term.Both short-term and long-term Eckardt scores were significantly lower compared to preoperative(P<0.001).Comparing the short-term and long-term Eckardt and Gerd Q scores after surgery,the Eckardt score increased from 2(0,3)in the short-term to 2(0.5,3)in the long-term,with a significant difference(P=0.010),and the Gerd Q score decreased from 6(6,9.5)in the short-term to 6(5.5,8)in the long-term,with a significant difference(P=0.044).The incidence of short-term and long-term symptomatic reflux in 45 patients with more than 3 years of postoperative follow-up was analyzed and grouped by BMI:28.89%of short-term symptomatic reflux and 33.33% of long-term symptomatic reflux,with no significant difference compared with each other(P> 0.05);22 patients(48.89%)had an increase in BMI group,and none of them were in the overweight or obese group before surgery The BMI of the patients reached normal after surgery.Multifactorial analysis showed that preoperative Eckardt score(OP=0.183,P=0.005)was a risk factor for surgical outcome.Conclusions:POEM surgery has been shown to be effective in the short and long term in treating patients with cardia incontinence.The incidence of postoperative symptomatic reflux may increase with time,but pharmacologic treatment is effective,and patients may experience a significant increase in BMI after POEM.Multifactorial analysis showed that the preoperative Eckardt score was a risk factor for the efficacy of the procedure.