Clinical research to patients with achalasia after peroral endoscopic myotomy therapy by high resolution manometry

Abstract

Objective To investigate the effects of peroral endoscopic myotomy （POEM） on esoph- ageal dynamics in patients with achalasia （AC） and appraise the role of high resolution manometry （HRM） in assessment of POEM therapy. Methods From July 2011 to September 2012, 20 patients with aehalasia underwent POEM in the department of gastroenterology, Tianjiu Medical University General Hospital. Preoperation esophageal dynamics of all the patients were evaluated by high resolution manometry （ HRM ） system and one month after POEM operation the test was repeated. Data of lower esophageal sphincter （LES） and esophageal body were analyzed, with 15 healthy volunteers as a contrast study. Results After POEM, the LES pressure （LESP） and 4-second integrated relaxation pressure （4slRP） significantly decreased： LESP [ pre-operation （24. 5 ± 13. 1 ） mm Hg vs. post-operation （ 8.5 ± 3.1 ）mm Hg, P 〈 0. 05 ] ; 4slRP [ pre-operation （20. 7 ± 6. 8 ） mm Hg vs. post-operation （ 5.0 ±3.4） mm Hg, P 〈 0. 05 ]. The LES relax rate （LESRR） significantly elevated [ pre-operation （ 12. 7± 9. 8 ） % vs. post-operation （ 39. 6 ± 18.1 ） % , P 〈0. 05]. However, the esophageal aperistalsis remained after POEM. The total of 20 patients were all type I aehalasia and responded well to POEM therapy. Post-operation data on the symptom scores markedly decreased and a significant correlation was found between the decreasing level of symptom scores and LESP, as well as the scores 4slRP in the 20 patients （ LESP ： r = 0. 751,P 〈 0. 05 ; 4slRP ： r = 0. 500, P 〈 0. 05 ）. Conclusion POEM can significantly improve esophageal dynamics in patients with aehalasia and the treatment outcome is definite. HRM plays an important role in evaluation of POEM therapy on achalasia, Key words: Achalasia; Peroral endoscopic myotomy; High resolution manometry