Departments of Surgery and Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
Gastrointest Endosc. 2013 Jan;77(1):29-38. doi: 10.1016/j.gie.2012.08.018. Epub 2012 Oct 6.
Peroral endoscopic myotomy (POEM) is a novel approach to performing esophageal myotomy through a long submucosal tunnel.
This study aimed to investigate the feasibility and safety of POEM for treatment of achalasia.
Preclinical animal study and prospective clinical study.
Consecutive patients diagnosed with achalasia with high-resolution manometry.
POEM was standardized for preclinical and clinical studies. After submucosal injection, a mucosal incision was made 15 cm above the gastroesophageal junction (GEJ). A long submucosal tunnel was created to extend below the GEJ. The endoscopic myotomy started 10 cm above and extended 2 cm below the GEJ. We first conducted a preclinical animal study to confirm the safety of POEM. POEM was then performed for the treatment of achalasia in humans.
Relief from dysphagia assessed by the dysphagia score and Eckhardt score. High-resolution manometry and pH monitoring were performed to evaluate the posttreatment effects and esophageal acid exposure.
Seven 30-kg porcine models underwent POEM in the survival study. All of the pigs survived except 1, which sustained pneumomediastinum. POEM was performed for the treatment of achalasia in 16 patients. The mean operating time was 117.0 ± 34.1 minutes. All patients tolerated food on day 2, with a contrast study confirming no leakage. The median follow-up was 176.5 days (range 98-230 days). The postoperative basal lower esophageal sphincter pressure was significantly reduced (mean reduction, 13.9 ± 14.5 mm Hg; P = .005) and 4-second integrated relaxation pressure of the GEJ (mean reduction, 10.1 ± 7.4 mm Hg; P = .001). Of these patients, 58.3% had a normalized 4-second integrated relaxation pressure, whereas 20% had excessive esophageal acid exposure after the procedure. There was a significant improvement in quality of life 6 months after POEM measured by the Short Form-36 questionnaire.
Small sample size.
POEM is a feasible, safe, and effective treatment for achalasia.
经口内镜下肌切开术（POEM）是一种通过长黏膜下隧道进行食管肌切开的新方法。
本研究旨在探讨 POEM 治疗贲门失弛缓症的可行性和安全性。
临床前动物研究和前瞻性临床研究。
连续诊断为贲门失弛缓症并进行高分辨率测压的患者。
POEM 经过临床前和临床研究的标准化。黏膜下注射后，在胃食管交界处（GEJ）上方 15cm 处进行黏膜切开。创建一个长的黏膜下隧道，延伸至 GEJ 下方。内镜肌切开术从 GEJ 上方 10cm 开始，向下延伸 2cm。我们首先进行了临床前动物研究，以确认 POEM 的安全性。然后，POEM 用于治疗人类贲门失弛缓症。
通过吞咽困难评分和 Eckhardt 评分评估吞咽困难缓解情况。进行高分辨率测压和 pH 监测，以评估治疗后的效果和食管酸暴露情况。
7 只 30kg 的猪在生存研究中接受了 POEM。除 1 只发生气胸外，所有猪均存活。POEM 用于治疗 16 例贲门失弛缓症患者。平均手术时间为 117.0±34.1 分钟。所有患者均在第 2 天耐受进食，对比研究证实无渗漏。中位随访时间为 176.5 天（范围 98-230 天）。术后基础下食管括约肌压力明显降低（平均降低 13.9±14.5mmHg；P=0.005），GEJ 4 秒内集成松弛压力也明显降低（平均降低 10.1±7.4mmHg；P=0.001）。这些患者中，58.3%的患者 4 秒内集成松弛压力恢复正常，而 20%的患者术后食管酸暴露过多。POEM 术后 6 个月，通过健康调查简表（SF-36）评估，生活质量显著改善。
样本量小。
POEM 是一种可行、安全且有效的贲门失弛缓症治疗方法。
