Shah A K, Wolfsen H C, Hemminger L L, Shah A A, DeVault K R
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA.
Dis Esophagus. 2006;19(5):335-9. doi: 10.1111/j.1442-2050.2006.00592.x.
Esophageal dysmotility is common in patients with Barrett's esophagus. Previously we have reported deterioration of esophageal motility after photodynamic therapy (PDT) in a heterogeneous group of patients with esophageal carcinoma. This prospective study in consecutive patients describes changes in motility noted after endoscopic ablation. Forty-seven patients referred to our institution for endoscopic ablation for Barrett's high grade dysplasia or mucosal carcinoma between August 2001 and May 2003 were prospectively evaluated with esophageal manometry before and after porfimer sodium PDT. Six patients did not complete the study. Manometry results were classified as normal, diffuse esophageal spasm, ineffective esophageal motility, or aperistalsis. Abnormal esophageal motility was found in 14 of 47 (30%) patients at study entry ([diffuse esophageal spasm] DES-3, [ineffective esophageal motility] IEM-7, Aperistalsis-4). After PDT, 11 of 41 patients with paired studies experienced a change in manometric diagnosis. Three patients had an improvement in motility, seven a worsening and one changed diagnosis, but did not particularly worsen or improve. No patient developed new aperistalsis. Therefore, abnormal motility was present in 19 of 41 (46%) patients after PDT (DES-2, IEM-14, Aperistalsis-3). There was a statistically significant (P = 0.016) relationship with longer segment Barrett's esophagus and deterioration of function. Baseline abnormalities in motility can occur in patients with Barrett's high-grade dysplasia or mucosal carcinoma. Changes in esophageal function also may occur following photodynamic therapy, but usually are not clinically significant. Worsening in function was more likely to occur in patients with longer segment Barrett's esophagus.
食管动力障碍在巴雷特食管患者中很常见。此前我们报道过，在一组异质性食管癌患者中，光动力疗法（PDT）后食管动力会恶化。这项针对连续患者的前瞻性研究描述了内镜下消融术后观察到的动力变化。2001年8月至2003年5月期间，47例因巴雷特高级别异型增生或黏膜癌转诊至我院接受内镜下消融的患者，在接受卟吩姆钠光动力疗法前后接受了食管测压的前瞻性评估。6例患者未完成研究。测压结果分为正常、弥漫性食管痉挛、无效食管动力或无蠕动。研究开始时，47例患者中有14例（30%）存在异常食管动力（弥漫性食管痉挛3例、无效食管动力7例、无蠕动4例）。光动力疗法后，4例进行配对研究的患者中有11例测压诊断发生了变化。3例患者动力改善，7例恶化，1例诊断改变，但未特别恶化或改善。没有患者出现新的无蠕动情况。因此，光动力疗法后，41例患者中有19例（46%）存在异常动力（弥漫性食管痉挛2例、无效食管动力14例、无蠕动3例）。巴雷特食管段较长与功能恶化之间存在统计学显著相关性（P = 0.016）。巴雷特高级别异型增生或黏膜癌患者可能出现基线动力异常。光动力疗法后食管功能也可能发生变化，但通常在临床上不显著。食管段较长的患者功能更有可能恶化。
