Health-Related Quality of Life and Physiological Outcomes of Peroral Endoscopic Myotomy for Achalasia

作者：Benedict Jacob J; Golas Adam A; Richter Joel E; Velanovich Vic^*

来源：Journal of Laparoendoscopic & Advanced Surgical Techniques, 2017, 27(8): 778-783.

DOI：10.1089/lap.2017.0087

• achalasia
• peroral endoscopic myotomy
• quality of life
• achalasia symptom questionnaire

Background: Peroral endoscopic myotomy (POEM) has gained acceptance as a treatment for achalasia. The aim of this study was to assess symptomatic, quality of life (QoL), and physiological outcomes of POEM using standardized methods.
Materials and Methods: Patients who were planned to undergo POEM were evaluated pre- and postoperatively with timed barium esophagogram (TBE), high-resolution manometry (HRM), the achalasia symptom questionnaire (ASQ) (best score 10, worst score 31), and the short form (SF)-36 (best score 100, worst score 0). Nine patients completed postoperative HRM, TBE, and 48 hours esophageal pH monitoring. A P-value of <.05 was considered statistically significant.
Results: A total of 34 of 37 patients completed the POEM procedure. There was improvement in the ASQ scores and in QoL. HRM integrated relaxation pressures (IRPs) improved from 31.4 +/- 10.8mmHg preoperatively to 12.3 +/- 6.7mmHg postoperatively, and lower esophageal sphincter pressure (LESP) improved from 49.1 +/- 16.9mmHg preoperatively to 23.1 +/- 9.4mmHg postoperatively. Of the 7 patients who were evaluated with 48-hour pH monitoring postoperatively, 5 patients (71%) demonstrated pathological reflux with an average Demeester score of 23.1 +/- 19.1. There was a negative linear correlation between LESP change and Demeester scores (r=-0.7, P=.03).
Conclusion: The POEM procedure significantly improves achalasia-related symptoms and improves social functioning. Physiologically, there is reduction in both IRP and LESP. Postoperative pathological reflux is correlated with LESP reduction.

• 出版日期2017-8