The Application Of Peroral Endoscopic Myotomy In Patients With Esophageal Achalasia

OBJECTIVE:To evaluate the efficacy and the feasibility of peroral endoscopic myotomy (POEM)for esophageal achalasia. To evaluate the application value of endoscopic ultrasonography examination before esophageal achalasia treated by peroral endoscopic myotomy.METHODS:From May2013to December2013,patients with AC underwent POEM in the First affiliated hospital of Guangxi Medical University had been followed up to study, according to clinical manifestation. The thickness of muscularis propria layer was measured at cardia,5cm,10cm and15cm above cardia by EUS before operation. Patients were followed up, Eckardt’s score were given to patients at the3rd and6th month after operation.RESULTS:The mean age of the patients is41.88±10.85years. The thickness of the muscularis propria layer at cardia,5cm,10cm and15cm above cardia was3.01±0.63mm,2.34±0.45mm,1.99±0.34mm,1.49±0.34mm.The average Eckardt’s score before operation was6.50±1.35. Spearman Rank Correlation analysis show that the Eckardt’s score was positive correlation to thickness of the muscularis propria layer at cardia, but had no relation to the clinical course. The operative time was90-240mins, the mean submucosal tunneling length was8～12cm. The average length of endoscopic myotomy of inner circular muscle was6～10cm. No serious complications related to POEM were encountered. The median follow-up period was7.5(range3-10) months. Dysphagia symptom was remission significantly during the follow-up period in all of them. The Eckardt’s score was1.04±0.96at three months after operation,1.00±0.78at six months after operation, which significantly decreased than pre-operation(P<0.05).CONCLUSION:1. The thickness of muscularis propria layer at cardia is positive correlation to the Eckardt’s score, but had no relation to the clinical course.2.As a novel therapy for AC, POEM appears to have definite short-term outcomes and can rapidly alleviate dysphagia symptom. Further observations and long follow-up are needed to evaluate long-term outcomes and complications.3. Before POEM treatment, EUS examination for AC patients has certain guiding significance.