| [Background & Aim]Peroral endoscopic myotomy(POEM)has been used for achalasia in clinic for six years.However,the large control trial about the short and long-term outcomes of POEM for achalasia was rarely reported.Then we discussed its efficacy and safety after long-term follow up retrospectively.At the same time,we found the complication rates were various in different literatures,espespecailly in gastroesophageal reflux disease(GERD).Then we analyzed the outcome of PO EM for achalasia and also compared and discussed the differences in different complications.The achalasia symptoms such as d ysphagia were well managed by POEM,while it's not sure that if it could influence the patient's quality of life(QoL).We also observed the poor mental state in achalasia patients.Then we compared the score of Qo L and mental states pre-operation and post-operation to show if POEM can improve the states of the patients' QoL and mental states.The efficacy of stent implantation was not inferior to pneumatic dialation(PD)in literature reports.But the comparative study about stent and PD or POEM was rare.With the development of endoscopic technology,our hospital had carried out the PD,stenting,and POEM for the treatment of achalasia successively.Then we did a single-centre retrospective study of the efficacy and safety difference in diffenrent treatments for achalasia.And it's the first comprehensive study to discuss the outcomes of stent impantation,PD and POEM.[Method] 1.Between December 2011 and September 2016,a total of 195 consecutive achalasia patients treated with POEM were chosen for study.All patients were confirmed by endoscopy,x ray contrast radiography,esophageal manometry and chest CT.Excluding the patients combining tumor in esophagus or cardia,hemorrhagic disorder and significant heart or lung disease,there were 192 patients in our study.The remission and complication rates were evaluated after a long time follow-up.Combining with the comlications rates reported in previous literatures,we analyzed the affecting factors on different complications.The QoL,self anxious score(SAS)and self depressive score(SDS)were conducted be fore and one-month after POEM on the patient who were hospitalized between September 2015 and September 2016.Then a compared study was conducted individually to show that whether there was improvement of POEM on them.2.The patients with diagnosed achalasia and treated with stent implantation,PD or POEM and being followed up continuously over three years between Mar 2008 and Dec 2013 were studied retrospectively.[Results] 1.After 1-58(21.1±13.6)months followed up,two patients were lost and there were 190 patients for study,84 male and 106 female.Among them,physical and mental health scores were evaluated before and after operation in 20 patients.The recent(<6 month)symptom relief rate and retreatment rate were 95.3%(181/190)and 0.5%(1/190)individually.The Eckardt score(P<0.001),LESP(P<0.001),width of esophagus(P<0.001),general health(P=0.003),mental health(P=0.019)and SAS(P=0.034)?SDS(P=0.030)were significantly improved one-month after POEM.The symptom relief rates of 1y,2y,3y and >3y were 91.7%(121/132)?85.1%(74/87)?82.5%(33/40)and 80%(24/30)individually,while the retreatment rates of them were 0%?0%?0%?6.7%(2/30).The Eckardt score after operation was significantly improved after three year follow-up(P<0.001).The short-term and long-term incidence of GERD were 8.3%(9/109)and 10%(3/30)individually.2.A total of 100 patients underwent metal stent placement(A,n=30),PD(B,n=35),or POEM(C,n=35).After a mean of 4.61±1.76 years follow-up,there were significant decrease in the Eckardt score and dysphagia score among three treatments after treatments.Their long-term symptom remission rates were 73.3%(22/30),62.9%(22/35)and 85.7%(30/35)individually and also with 20.0%(6/30),28.6%(10/35)and 2.86%(1/35)at the retreatment rate.There were no significant differences in Eckardt score among three groups among different time at 6mo,1y,2y,3y and >3y follow-up(P>0.05).However,the differences in dysphagia score(t=9.037,P=0.011)among three treatments were significant and also in symptom remission rate(?~2=6.752,P=0.023)at 6mo follow-up,while there also was differences in dysphagia score(t=14.931,P=0.001)at >3y follow-up.Comparing with each other,the dysphagia relief was better in group C than other groups(P<0.05),while the symptom remission rate was better in group C than group B(P<0.05)at 6mo follow-up.There were significant difference in retreatment rates among three groups at >3y follow-up in which it was lower in group C than B(?~2=8.737,P=0.003).The incidence of late complications were 100%(30/30),5.7%(2/35)and 11.4%(4/35)individually among three therapies,while group A was higher than other two groups(?~2=75.555,P<0.001).The long term complications' incidence rate was no diffenrence(?~2=3.906,P=0.106).[Conclusions] 1.The efficacy and safety of PO EM for AC was good.Meanwhile,POEM can significantly improve the patients' general health,especially in mental health and the state of anxiety and depressions.The incidence of GERD after operation was 8.3%-10%,which was at the low rate of the number(8.3%-65%)in previous literature reported.We consider that the possible reason of the low complication of GERD were the length or depth of myotomy and the position of mucosal incision on esophagus.2.The extent of dysphagia relief was obviously significant in POEM comparing with stents implanting and PD.Comparing with PD,POEM was higher in late remission rates while lower in long-term retreatment rate.The incidence of late complication rate was higher in metal stents placement,and its main complications were reflux esophagitis,ulcer and erosion of mucosa at marginal stent.While there was no difference in long-term follow-up comparing with others.The outcome of POEM for achalasia was excellent,and could be the good choice for achalasia. |
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