Abstract
BackgroundPeroral endoscopic myotomy (POEM) as a new approach to achalasia attracts broad attention. The primary objective of this study was to evaluate the results with esophageal motility after POEM through the first large sample clinical research.Patients and MethodsWe have a self-control research with all patients (205 in total) who underwent POEM from 2010 to 2014 at our Digestive Endoscopic Center, 66 patients of which underwent high resolution manometry (HRM) before and after POEM in our motility laboratory. Follow-ups last for 5.6 months on average. Outcome variables analyzed included upper esophageal sphincter pressure (UESP), upper esophageal sphincter residual pressure (UESRP), lower esophageal sphincter pressure (LESP), lower esophageal sphincter residual pressure (LESRP) and esophageal body peristalsis. We have a statistical analysis to illustrate how POEM impacts on the change of esophageal motility.ResultsThe symptoms related to dysphagia were relieved in 95% of patients in recent term after POEM. While HRM showed a statistically significant reduction of URSRP, LESP and LESRP (P<0.01), however, peristalsis was not consistently affected. There were 11 patients who had undergone other prior endoscopic treatment (endoscopic dilation or botulinum toxin injection) and 55 patients had not. The statistical difference (P>0.05) did not occur for these two groups on LESP and LESRP reduction.ConclusionsPOEM clearly relieved the symptoms related to dysphagia by lowering the pressure of upper esophageal sphincter (UES) and lower esophageal sphincter (LES),and other endoscopic treatment before POEM did not affect the improvement of LES pressure. These results are concluded from our short-term follow-up study, while the long-term efficacy remains to be further illustrated.Trial RegistrationChinese Clinical Trial Register ChiCTR-TRC-12002204)
Highlights
Achalasia is a neurodegenerative motility disorder of the esophagus resulting in absence of peristalsis on esophageal body and impaired relaxation of lower esophageal sphincter(LES) in response to swallowing
Peroral endoscopic myotomy (POEM) clearly relieved the symptoms related to dysphagia by lowering the pressure of upper esophageal sphincter (UES) and lower esophageal sphincter (LES),and other
POEM Can Improve Esophageal Motility in Patients with Achalasia endoscopic treatment before POEM did not affect the improvement of LES pressure
Summary
Achalasia is a neurodegenerative motility disorder of the esophagus resulting in absence of peristalsis on esophageal body and impaired relaxation of lower esophageal sphincter(LES) in response to swallowing. In 2010, peroral endoscopic myotomy (POEM) was reported clinically by Inoue and colleagues for the first time[1],the symptom remission rate of 93–100% [2,3,4,5,6] made the procedure an attractive primary therapeutic option for the patients with achalasia. We have no clinical research on large sample that evaluate the results after POEM by esophageal motility. We arrange our experience with POEM for the treatment of achalasia and the effect on esophageal motility. Peroral endoscopic myotomy (POEM) as a new approach to achalasia attracts broad attention. The primary objective of this study was to evaluate the results with esophageal motility after POEM through the first large sample clinical research.
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