Comparison Of Balloon Dilatation+botulinum Toxin Injection And POEM In Treating Achalasia Of Cardia(AC)

Background:Achalasia of cardia(AC) is a primary esophageal motility disorder, which is first reported more than300years ago,the incidence reported by Western countries is about0.55-1.63/100000, not significantly related to gender、age、races etc.The mancanism etiology remains unclear,usually accepted as Neurogenic disease. The main characteristic of AC is the disorder of relaxation of lower esophageal sphincter(LES) after swallowing and reduction of esophageal body peristalsis,so that food can not pass the cadia smoothly,which lead to a series of symptoms produced by retention,include dysphagia,chest pain, regurgitation and weight loss. At the beginning of the symptoms may not be obvious, and then slow progress, A few patient can progress rapidly,even asymptomatic, only occasionally recognized in routine chest X-ray examination and inspection of the respiratory tract. At present, the treatment of AC is almostly with open surgical oesophagoscope、endoscopic dilatation、Botox injections、Esophagus stent implantation and so on. In recent years, a new, promising technology-Peroral endoscopic myotamy(POEM),is reported with satisfactory efficacy.Object:to evaluate and compare the safty and clinical outcome of Balloon dilatation+botulinum toxin injection and POEM for treatment of AC.Subjects and Methods:Choose the patients treated in Shandong Provincial Hospital during2010.1---2014.03,who were diagnosed as AC through clinical manifestations, upper gastrointestinal barium meal, gastroscopy and esophageal manometry.They are respectively treated with Balloon dilatation+botulinum toxin injection(Group A) and POEM(Group B). Follow-up observation of efficiency were observed1month、6month、1year、2years after the operation.Results:After the treatment,no obvious complication was observed in group A, only a few patient complain about a mild chest pain which get relieved automatically;In group B,10patients were with a fever,12cases were with emphysema,4cases were with pneumothorax,generally,they were mild, and got recover quickly with general conservative treatment.4-6weeks after the treatment,the esophageal diameter decreased from5.21±1.11cm to2.30±0.67cm in group A,5,45±0.88cm to2.46±0.77cm in group B.In the1month、6month、1year、2years follow-up,the effiency was100%,93.8%,64.5%,47.6%respectively in group A,and in group B,the efficieny was92.5%、91.9%、90.0%、80%.Conclusions:These two tharepies can both Significantly relieve the symptoms of these patients,.Balloon dilatation+botulinum toxin injection is with less trauma,less spense, almost no postoperative complication,but less effective and shows more relapse in this2year follow-up.POEM is perfect in efficiency,though complications during or after the treatment common,but are usually mild,and can be easily controlled.