A comparative study on effects of three measuring methods for gastroesophageal reflux of post-POEM achalasia patients

Abstract Background Gastroesophageal reflux is a major complication of post-POEM (peroral endoscopic myotomy, POEM) for esophageal achlasia. Objective: To discuss the effects of three measuring methods for Gastroesophageal Reflux of Post-POEM Achalasia Patients and find out the best method for diagnosing post-POEM gastroesophageal reflux of esophageal achalasia patients by conducting clinical follow-up studies. Methods: Follow-up visits were conducted on the patients with esophageal achalasia who had received POEM treatment in our hospital from 2013 to 2016. Between 2 to 4 weeks post operation, Eckardt score was adopted to evaluate the operation efficacy, the GerdQ score, electronic gastroscopy and 24h esophagus impedance-pH monitoring to investigate the gastroesophageal reflux and the comparison of detection rate among the three different methods on post-POEM gastroesophageal reflux. Results: There were 76 patients with Eckardt scores were 3 or lower than 3 post POEM (76/78, 97.44%), 2 patients with Eckardt scores were 4 or higher than 4 (2/78, 2.56%), the cure rate of the treatment was as high as 97.44%; the Eckardt score post operation decreased more significantly than before operation, P<0.0.5. Conclusion: for post-POEM Achalasia patients, 24h esophagus impedance-pH monitoring is the best way to diagnose post-POEM gastroesophageal reflux.

**摘要**
背景：胃食管反流是食管贲门失弛缓症患者行经口内镜下肌切开术（peroral endoscopic myotomy, POEM）后主要并发症。
目的：探讨3种检测方法对POEM术后贲门失弛缓症患者胃食管反流的评估效果，并通过临床随访研究明确诊断该类患者术后胃食管反流的最优方法。
方法：对2013至2016年于我院接受POEM治疗的食管贲门失弛缓症患者开展随访。于术后2~4周时，采用埃卡德特评分（Eckardt score）评估手术疗效，采用胃食管反流病问卷（GerdQ score）评分、电子胃镜及24h食管阻抗-pH监测（24h esophagus impedance-pH monitoring）评估胃食管反流情况，比较3种方法对POEM术后胃食管反流的检出率。
结果：78例患者中，76例术后埃卡德特评分≤3分（76/78，97.44%），2例术后评分≥4分（2/78，2.56%），本次治疗的治愈率高达97.44%；患者术后埃卡德特评分较术前显著降低，P<0.05。
结论：对于贲门失弛缓症POEM术后患者，24h食管阻抗-pH监测是诊断其术后胃食管反流的最优方法。