Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Am J Gastroenterol. 2012 Mar;107(3):411-7. doi: 10.1038/ajg.2011.388. Epub 2011 Nov 8.
Endoscopic balloon dilatation and laparoscopic myotomy are established treatments for achalasia. Recently, a new endoscopic technique for complete myotomy was described. Herein, we report the results of the first prospective trial of peroral endoscopic myotomy (POEM) in Europe.
POEM was performed under general anesthesia in 16 patients (male:female (12:4), mean age 45 years, range 26-76). The primary outcome was symptom relief at 3 months, defined as an Eckhard score ≤3. Secondary outcomes were procedure-related adverse events, lower esophageal sphincter (LES) pressure on manometry, reflux symptoms, and medication use before and after POEM.
A 3-month follow-up was completed for all patients. Treatment success (Eckhard score ≤3) was achieved in 94% of cases (mean score pre- vs. post-treatment (8.8 vs. 1.4); P<0.001). Mean LES pressure was 27.2 mm Hg pre-treatment and 11.8 mm Hg post-treatment (P<0.001). No patient developed symptoms of gastro-esophageal reflux after treatment, but one patient was found to have an erosive lesion (LA grade A) on follow-up esophagogastroduodenoscopy. No patient required medication with proton pump inhibitors or antacids after POEM.
POEM is a promising new treatment for achalasia resulting in short-term symptom relief in >90% of cases. Studies evaluating long-term efficacy and comparing POEM with established treatments have been initiated.
内镜球囊扩张术和腹腔镜肌切开术是治疗贲门失弛缓症的既定疗法。最近，一种新的内镜全层肌切开术技术被描述出来。在此，我们报告了欧洲首例经口内镜肌切开术（POEM）的前瞻性试验结果。
16 例患者（男：女 12:4，平均年龄 45 岁，范围 26-76 岁）在全身麻醉下进行 POEM。主要结局是 3 个月时的症状缓解，定义为 Eckhard 评分≤3。次要结局是与操作相关的不良事件、测压时食管下括约肌（LES）压力、反流症状以及 POEM 前后的药物使用情况。
所有患者均完成了 3 个月的随访。94%的病例（治疗前平均评分 8.8 vs. 治疗后 1.4；P<0.001）达到了治疗成功（Eckhard 评分≤3）。治疗前 LES 压力为 27.2mmHg，治疗后为 11.8mmHg（P<0.001）。治疗后没有患者出现胃食管反流症状，但有 1 例患者在随访食管胃十二指肠镜检查时发现有糜烂性病变（LA 分级 A）。POEM 后没有患者需要使用质子泵抑制剂或抗酸剂进行药物治疗。
POEM 是治疗贲门失弛缓症的一种很有前途的新方法，90%以上的病例在短期内可缓解症状。目前已经开展了评估长期疗效并将 POEM 与既定疗法进行比较的研究。
