The Effect Of POEM On Esophageal Function And Symptom In Patients With Achalasia

Research purposes:To evaluate the effect of POEM on esophageal function and symptomsin patients with achalasia, and to find features and rules to guide furtherdevelopment of POEM treatment.Materials and methods:A total of12patients underwent POEM at the first hospital of jilinuniversity from April2013to April2014were enrolled in the study.There were4male and8female, with a mean age of （38.92±14.36）years, their mean duration of symptoms was （4.79±6.67） years.According to the classification in Chicago, there were six type Ⅰ patients,and six type Ⅱ patients. Before and1months after POEM treatment,12patients underwent Eckardt score、 HRM test and comparisonEckardtscore、Lower esophageal sphincter pressure(LESP）、Loweresophageal sphincter relaxation rate （LESRR）、 Lower esophagealsphincter length（LESL）, to observe the effect and complications.Results:In all cases, POEM were successfully performed without any severecomplications. After surgery,6cases were of fever, three of themtemperature over38℃, blood culture shows three days of sterile growth,all of them improved by anti-inflammatory, symptomatic and supportive therapy. Chest CT show all patients had varying degrees of gas inmediastinum, abdomen and lung, blood oxygen saturation in the normalrange, breathing steadily, so did not give special treatment,1week afterchest CT show less gas than before.8patients chest CT show a smallamount of pleural effusion on both sides, with no correspondingsymptoms such as difficulty in breathing, not special treatment, chest CTcheck after1week suggest less effusion quantity than before. One weekafter operative,1patient review endoscopy shows mucosal erosion incardiac part, endoscopy have a slightly resistance, cardiac opening islimited, this patient had surgery in cardiac part, local fibrosissignificantly, increased operative difficulty and mucosal repair ability ispoor. Giving local mucosal protective agents protect the mucosa sprayand covered in endoscopic esophageal stent indwelling protect localwound, one week after review endoscopy again shows esophagealmucosa is smooth, esophageal stent is not displaced, expansion is goodand smooth interior, so had surgery to remove esophageal stentsommthly.1months after POEM all patients had Eckardt score, meanpost-treatment Eckardt score was (0.50±0.52), compared with meanpre-treatment (6.25±1.29) down (5.75±1.06),P<0.05difference wasstatistically significant. HRM test were done in all patients1months after POEM, meanpost-treatment LESP was （6.93±5.46）mmHg, compared with meanpre-treatment （30.43±16.39） mmHg dropped (23.50±19.77) mmHg,P<0.05, the difference was statistically significant; however, the thedecreases in LESRR and LESL were not statisticallysignificant(P>0.05).Comparison parameters before and after surgery inpatients with different gender achalasia and two types of achalasia foundno statistically significant difference(P>0.05).Conclusion:After POEM, patients with achalasia significantly relieve symptomsand reduce lower esophageal sphincter pressure, improve the quality oflife.Patient who have a failure endoscopic or surgical treatment can stilltreatment with POEM and have a good effect.