The Analysis Of POEM To The Outcome Of The Treatment To The Patients With Different Types Of Achalasia

Objective:To analyze the outcome of different surgical methods to the patients with different types of achalasia by comparing the intervention results of POEM(peroral endoscopic myotomy)to the esophageal functional parameters and symptoms of patients with different types of achalasia.Methods:A total of 20 patients treated at digestive department of our hospital from October 2014 to October 2016 and up to the standard for enrollment were enrolled in the study.There were 10 male and 10 female,with a mean age of(47.25± 13.40)years,their mean duration of symptoms was(4.00±2.53)years.There were 9 patients with treatment before and 11 patients without treatment before.According to the esophageal manometry and classification in Chicago,there were 6 type 1 patients and 14 type 2 patients.All the patients received POEM in the hospital,we used Eckardt scores to compare the improvement of the symptoms before and after treatment between the patients in two groups;we compared the variation of Lower esophageal sphincter pressure(LESP),Lower esophageal sphincterlength(LESL)by undertaking High resolution manometry(HRM)of the 20 patients,to observe and compare the outcome of POEM and the occurrence situation of complications between patients with different types of achalasia.We used SPSS 19.0 to make statistical analysis.Results:The 20 patients reaching the exclusion criteria all received the POEM successfully.According to the Chicago classification,there were 6 patients with type 1 achalasia,including 4 male and 2 female,and 1 patient with oral drug therapy before,about the 6 patients,the mean age was(40.17±13.17)years,the mean duration of symptoms was(3.17±1.94)years,the mean number of hospitalization time after the surgery was(10.00±2.10)days,and the mean surgery time was(60.67±27.32)min.There were 14 patients with type 2 achalasia,including 6 male and 8 female,and 6 patients with oral drug therapy before,1 patient with creotoxin therapy before,2 patients with balloon dilatation before,about the 14 patients,the mean age was(50.29±12.75)years,the mean duration of symptoms was(4.36±2.74)years,the mean number of hospitalization time after the surgery was(11.57±2.77)days,and the mean surgery time was(67.86±20.11)min.There were no statistic differences between the initial values of the patients with type 1 and type 2 achalasia(p>0.05).The comparison of patients with type 1 and type 2 achalasia showed no statistic differences in the occurrence situation of intraoperative complications(hemorrhage,mucous layer damage,subcutaneous emphysema in thorax,pneumoperitoneum),post-operative complications(small amount of pleural effusion,infection and fever,pneumothorax,pneumoperitoneum,mediastinal free gas)and untoward effect(epigastralgia,abdominal distension,chest distress and the short of breath)between the patients with different types of achalasia.We compared the parameters before and after the POEM between the patients with different types of achalasia,the comparison of different value of Eckardt scores before and after the POEM showed P=0.01;the comparison of different value of LESP parameters before and after the POEM showed P=0.02,both with statistical significance.However the comparison of LESL showed P=0.35,with no statistical significance.Conclusion:1.The success rate of POEM were not influenced obviously by the differences in gender,age,course of disease and the situation of treatment before.2.The security coefficient of the POEM was satisfactory and there were no significant differences in the occurrence situation of intraoperative complications and postoperative complications between the patients with different types of achalasia.3.The POEM showed significantly outcome in both type 1 and type 2 achalasia,and the Eckardtscore and the LESP parameters in HRM after the POEM in type 2 were improved more obviously.