The Outcomes And Quality Of Life After Peroal Endoscopy Myotomy(POEM) For Achalasia In Short Time

Background:With medical model altering from the physical-medical model to the biological-psychology-social model, the treatment is not only for the physicial, but also for the phycological and the well being of life, so assessing the health related quality of life(HRQOL) at the same time will be very important. Achalasia is a chronic progressive disease, and the HRQOL decreases sharply by the cost of the money, energy and time for treatment. Fortunately, the peroal endoscopy myotomy(POEM) is a newer treatment of achalasia, and lots of researches have found its helpfulness, however, rare foreign research the HRQOL after POEM, especially in this area is blank in China. Therefore, We want to explore the outcomes and QOL after POEM for achalasia in short time.Objects:To assess the outcomes and HRQOL after POEM for achalasia in short time.Methods:35cases of patients are treated by POEM. We investigate Eckardt score and check gastroscope and esophageal barium to assess the clinic effectiveness, and the same time, use36items concise scale (SF-36) to evaluate the quality of life.Results:All the35patients undergo POEM successfully, the rate of success is100%, and the mean operation time is55minutes. The average length of tunnel and myotomy are14.1cm and10.6cm respectively. Eckardt’s scores decreases significantly postoperative1month, and6months (0.51vs.6.83,0.45vs6.83, P<0.05); and postoperative esophagus diameter is reduced significantly too(32.00mm vs.47.97mm,28.50mm vs.47.97mm, P <0.05). Complications occurre in14.3%(5/35) of the cases, gas-related complications is8.6%(3/35), the reflux is1.5%(1/35), and stubborn hiccup is1.5%(1/35). Treatment effectiveness rate is100%with a follow-up of3.5-10months (median6.4months), no recurrence is noted. The HRQOL of eight dimensions are lower than the general people, and are promoted than the preoperative (P<0.05), and are higher than the general people. Eckardt score is negatively correlated with postoperative QOL (P<0.05); And the correlation between the preoperative SF-36and the percentage of improvement after POEM is negative(P<0.05); The HRQOL of the physical dimension decreases as the age of the case increases.Conclusions:1. POEM is safe and effective for achalasia, and can significantly improve the manifestation and shrinke the dilation of the oesophagus.2. The HRQOL of the achalasia is lower than the general people, postoperative HRQOL is promoted significantly, even higher than the general people; And the better the manifestations, the better the HRQOL; And The worse the preoperative HRQOL, the higher the percentage of improvement; And for the elder group, it has lower HRQOL than the younger one.