Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama 224-8503 Japan.
Endoscopy. 2010 Apr;42(4):265-71. doi: 10.1055/s-0029-1244080. Epub 2010 Mar 30.
Peroral endoscopic myotomy (POEM) was developed by our group to provide a less invasive permanent treatment for esophageal achalasia.
POEM was performed in 17 consecutive patients with achalasia (10 men, 7 women; mean age 41.4 years). A long submucosal tunnel was created (mean length 12.4 cm), followed by endoscopic myotomy of circular muscle bundles of a mean total length of 8.1 cm (6.1 cm in distal esophagus and 2.0 cm in cardia). Smooth passage of an endoscope through the gastroesophageal junction was confirmed at the end of the procedure.
In all cases POEM significantly reduced the dysphagia symptom score (from mean 10 to 1.3; P = 0.0003) and the resting lower esophageal sphincter (LES) pressure (from mean 52.4 mmHg to 19.9 mmHg; P = 0.0001). No serious complications related to POEM were encountered. During follow-up (mean 5 months), additional treatment or medication was necessary in only one patient (case 17) who developed reflux esophagitis (Los Angeles classification B); this was well controlled with regular intake of protein pump inhibitors (PPIs).
The short-term outcome of POEM for achalasia was excellent; further studies on long-term efficacy and on comparison of POEM with other interventional therapies are awaited.
经口内镜下肌切开术（POEM）由我们团队开发，旨在为贲门失弛缓症提供一种微创的永久性治疗方法。
17 例贲门失弛缓症患者（男 10 例，女 7 例；平均年龄 41.4 岁）连续接受了 POEM 治疗。创建了一个长的黏膜下隧道（平均长度 12.4cm），随后进行了环形肌肉束的内镜肌切开术，总长度平均为 8.1cm（远端食管 6.1cm，贲门 2.0cm）。在手术结束时，确认内镜能够顺利通过食管胃交界部。
在所有病例中，POEM 显著降低了吞咽困难症状评分（从平均 10 分降至 1.3 分；P = 0.0003）和静息下食管下括约肌（LES）压力（从平均 52.4mmHg 降至 19.9mmHg；P = 0.0001）。未发生与 POEM 相关的严重并发症。在随访期间（平均 5 个月），仅 1 例患者（病例 17）出现反流性食管炎（洛杉矶分类 B），需要额外的治疗或药物治疗；通过定期服用质子泵抑制剂（PPIs），得到了很好的控制。
POEM 治疗贲门失弛缓症的短期疗效极佳；期待进一步研究其长期疗效，并与其他介入治疗方法进行比较。
