Evaluation Of High-resolution Esophageal Manometry In Patients With Peroral Endoscopic Myotomy

BackgroundAchalasia,or cardia spasm,refers to the pharyngeal esophageal motility without swallowing,poor cardia sphincter relaxation.It is characterized by esophageal movement disorder.Etiology is unknown.It is generally believed that the occurrence of the disease is related to the degeneration,reduction and absence of ganglion in the esophageal muscle layer,which leads to the loss of normal driving force of the esophagus.With the development of high-resolution esophageal manometry(HRM),achalasia has become more deeply understood.The number of cases of achalasia diagnosed gradually increased.As the incidence has increased obviously,medical workers have made progress in the diagnosis and treatment of the diseases.At present,the main treatment methods are non-surgical treatment(such as drug treatment,endoscopic treatment),surgical treatment and so on.ObjectIn this study,we collected 42 patients with AC,analyzed its general clinical features,changes in esophageal manometry before and after surgery,and discussed the value of HRM in the evaluation of AC to improve the understanding of the disease and reduce the misdiagnosis rate.MethodsFrom August 2015 to November 2017,42 patients were diagnosed as AC and treated with peroral endoscopic myotomy(POEM)in the digestive department of the First Affiliated Hospital of Zhengzhou University.We performed HRM before surgery,1 week after surgery,1 month after surgery,and 6 months after surgery to detect the esophageal sphincter pressure(LESP)on the esophagus and the resting pressure of the lower esophageal sphincter.(upper esophageal sphincter pressure,UESP),four seconds integrity relaxation pressure(4sIRP),esophageal contraction peristalsis and other indicators.Clinical symptoms were evaluated according to the Eckard score.Evaluate the efficacy of the retrospective analysis.SPSS 21.0 software was used for statistical analysis.The normal distribution of measurement data is expressed as mean±standard deviation(x±s)using two independent samples t-test.Correlation analysis uses Pearson product moment correlation.P<0.05 was considered statistically significant.Results1.The distribution of AC patients did not have a clear gender distinction.The proportion of males and females was quite similar,with the majority being 20-60 years old,accounting for 81%(34/42).The early clinical manifestations of the disease were not specific,and were easily misdiagnosed.It always had a long history before the diagnosis.Difficulty in swallowing(26/42)was the most common clinical symptom in the late stage,and a few were associated with respiratory symptoms(2/42).2.Surgical wound ulcer(9/42),hemorrhage(2/42),subcutaneous emphysema(1/42),thoracic and abdominal gas(1/42),infection(1/42)and other complications may appear after operation.But Serious complications that require surgery are rare.3.For AC patients,synchronous contraction waves appeared in all patients instead of the normal peristaltic waves.None of the patients recovered normal esophageal propulsive contractions.LESP is not necessarily elevated,so it cannot be used as a diagnostic criterion.There was no significant difference in UESP before and after POEM(P>0.05).The difference between preoperative and postoperative 4sIRP or LESP was statistically significant(P<0.05).However,the difference was not statistically significant at 1 week postoperatively,1 month postoperatively and 6 months postoperatively(P>0.05).4.Postoperative dysphagia symptoms were significantly improved,and the Eckard score decreased significantly after surgery(P<0.05).Moreover,the decline of Eckard score was correlated with the decline of LESP and the decline of 4sIRP(r=0.737,P<0.05;r=0.679,P<0.05).ConclusionsThe clinical manifestations of AC have no obvious specificity,and diagnosis is not easy.The HRM image portrays the patient's esophageal pressure and esophageal peristalsis and contributes to increase the diagnostic rate.The short-term efficacy of POEM is significant and stable,with less postoperative complications and less patient suffering.Using HRM to perform simple and objective follow-up of AC patients is helpful in assessing the efficacy of POEM and monitoring changes in the condition.