The clinical application evaluation of peroral endoscopic myotomy and endoscopic pneumatic dilation for achalasia

Abstract

Objective To assess the clinical application value of peroral endoscopic myotomy and endoscopic pneumatic dilation in treating achalasia. Methods 80 patients with achalasia from Jan. 2015 to Jun. 2016 were chosen, and were divided into observation group and control group by the stratified randomization method. The control group was treated by endoscopic pneumatic dilation (PD), while the observation group was treated by peroral endoscopic myotomy (POEM). Eckardt score and high resolution manometry (HRM) were compared between the two groups before surgery, one month and one year after surgery. The recurrence rate and complication rate were compared between the two groups. Results One month and one year after surgery, Eckardt score of the two groups were lower than those before surgery, and Eckardt score of POEM group was lower than that of PD group at one year after surgery, with statistically significant differences (P<0.05). Lower esophageal sphincter pressure (LESP) and 4 second integrate relaxation pressure (4S-IRP) of the two groups after surgery were lower than those before after surgery, and lower esophageal sphincter relaxation rate (LESRR) and lower esophageal sphincter length (LESL) were higher than those before after surgery, and LESP and 4S-IRP of POEM group after surgery were lower than those of PD group, LESRR and LESL of POEM group after surgery were higher than those of PD group, with statistically significant differences (P<0.05). Compared to the control group, the recurrence rate and complication rate were lower in the observation group, with statistically significant differences (P<0.05). Conclusion Compared to PD, POEM is proved to be a very effective treatment for achalasia, with low recurrence rate and few complications, with significant clinical application value. Key words: Peroral endoscopic myotomy; Pneumatic dilation; Achalasia; Clinical efficacy