Clinical efficacy assessment of peroral endoscopic myotomy therapy in patients with achalasia of cardia followed up for three years

Abstract

Objective To observe the clinical efficacy of peroral endoscopic myotomy (POEM) in patients with achalasia of cardia followed up three years and assess the value of high resolution manometry (HRM) and esophageal barium meal in assessment of POEM therapy. Methods From April 2011 to December 2013, 58 patients diagnosed as achalasia of cardia and accepted POEM therapy were collected. Before operation, at one month, six months, one year, two years and three years after operation, low esophageal sphincter pressure (LESP), low esophageal sphincter relaxation rate (LESRR), four seconds integrity relaxation pressure (4sIRP) and proportion of effective esophageal body peristalsis were detected by HRM; maximum diameter of esophageal was examined by esophageal barium meal and the efficacy was evaluated with Eckardt score system. The t test was performed for normal distributed measurement data. Rank sum test was used for non normal distributed measurement data. Pearson product moment was performed for correlation analysis. Results POEM was successfully completed in 58 patients with achalasia of cardia. At one month, six months, one year, two years and three years after operation, the Eckardt score was 0 (0 to 1), 1 (0 to 2), 1 (0 to 2), 1 (0 to 4), 2 (0 to 4), respectively, compared with that of before operation (7, 5 to 9) and the differences were statistically significant (Z=-4.134, -4.124, -4.135, -4.121 and -3.656, all P<0.05). The differences in LESP, LESRR and 4sIRP between before operation and at one month, six month, one year, two years and three years after operation were statistically significant (tLESP=4.968, 6.301, 5.757, 4.716 and 5.608; tLESRR=-5.364, -5.080, -4.965, -4.755 and -4.348; t4sIRP=6.334, 8.422, 7.423, 6.507 and 5.627; all P<0.05). At one month, six month, one year, two years and three years after operation, the maximum diameter of esophageal was (3.51±1.27) cm, (3.47±1.26) cm, (3.60±1.26) cm, (3.66±1.53) cm and (3.82±0.90) cm, respectively, compared with that before operation ((6.29±1.69) cm), the differences were statistically significant (t=4.898, 6.116, 4.452, 4.650 and 4.187, all P<0.05). At three years after operation, there were correlations between the maximum diameter of esophageal and Eckardt score, between 4sIRP and Eckardt score, and even between 4sIRP and the maximum diameter of esophageal (r=0.635, 0.844 and 0.729, all P<0.05). Conclusions The short and medium term efficacy of POEM in patients with achalasia of cardia is good. HRM and barium meal examination could objectively reflect the efficacy of POEM. Key words: Achalasia of cardia; Peroral endoscopic myotomy; High resolution manometry; Barium meal