Efficacy assessment of 33 cases of peroral endoscopic myotomy in different achalasia subtypes by esophageal high-resolution manometry / 中华消化杂志

ABSTRACT

Objective To explore the symptomatic improvement of different achalasia (AC)subtypes after peroral endoscopic myotomy (POEM) procedure.Methods A total of 33 patients received POEM for the first time were enrolled.Patients were evaluated by high-resolution manometry (HRM)and subtyped by Chicago classification criteria.The total scores of symptoms were evaluated by Eckardt scale before and after POEM.Solid food dysphagia,liquid dysphagia,reflux and chest pain were scored by five-point Likert scales and compared by Wilcoxon paired test.Multiple linear regression analysis was performed to analyze key factors affecting the prognosis of symptoms.Results Among 33 AC patients,there were 20 females and the mean age was (44.0± 13.3) years.According to Chicago criteria,four patients had subtype Ⅰ AC,25 patients had subtype Ⅱ AC,and four patients with subtype Ⅲ achalasia.Before operation,the total Eckardt score was 7.5(6.3,10.0),which declined to 1.5 (1.0,3.0) after operation,and the difference was statistically significant (Z=-4.795,P ＜ 0.01).There was no statistically significant difference in the incidence of solid food/liquid dysphagia,reflux and chest pain among subtypies.Solid food dysphagia was the main symptom of each AC subtypes.POEM could improve all the symptoms of subtype Ⅱ AC except for chest pain.Before and after POEM,solid food dysphagia score was 16.0 (12.0,16.0) and 2.0 (1.0,12.0),liquid dysphagia score was 2.0 (0.0,5.0) and 0.0(0.0,0.0),reflux score was 9.0 (6.0,9.0) and 0.0 (0.0,1.0),respectively,and the differences were statistically significant (Z =-3.929,-3.470,1.841;all P＜ 0.01).The results of multiple linear regression analysis indicated that female and 4 s integrated relaxation pressure (4 s IRP) of 10 mL continuous swallows were positively correlated with symptom scores of solid food dysphagia (β 3.950,P=0.048;β=0.376,P=0.005);While 4 sIRP in solid food swallow was negatively correlated with symptom scores of solid food and liquid dysphagia (β=-0.244,P =0.008;β=-0.118,P =0.037).Conclusion For patients with AC,clinical symptoms could be significantly improved by single treatment of POEM,but there are certain differences in the symptomatic improvement among different subtypes.