Gastroenterology and Hepatology Unit, Hospital de Cruces, Medical School, University of the Basque Country, Plaza de Cruces s/n, 48903, Barakaldo, Basque Country, Spain,
Dig Dis Sci. 2013 Mar;58(3):788-96. doi: 10.1007/s10620-012-2476-x. Epub 2012 Nov 22.
Endoscopic sclerotherapy (EST) with ethanolamine oleate (EO) was proposed as a treatment for achalasia, based on the well-known necrotizing effect against the esophageal muscle layers. The aim of this study is to evaluate long-term efficacy of EST.
Four consecutive series of patients with achalasia were treated according to different schedules over a period of 20 years, by using EO or polidocanol (PD). The primary outcome was dysphagia relief. Secondary outcomes were lower esophageal sphincter pressure, esophagogram, gastroesophageal reflux and endoscopic ultrasonography (EUS). Patients not responding to EST were treated with 30 mm dilation.
A total of 103 patients completed the treatment. On medium-term evaluation, 75 patients who completed the treatment reached a clinical response labeled as "good," 23 were assessed as "fair," and 5 were assessed as failures. EUS has become a very informative tool to guide the treatment. The overall follow-up lasted for 87.9 ± 66.7 months. Twelve patients experienced a late failure. The cumulative expectancy of being free of recurrence was 90 % at 50 months with EO, but it was only 65 % with PD. Those patients who responded to rescue measures remained in good or fair clinical condition during the remaining follow-up. Young age, PD, and the so-called fusiform pattern on esophagogram proved to be significant predictors of poor prognosis.
EST with EO is a promising alternative to classic therapies for achalasia. In contrast, PD-treated patients showed an important trend to fibrosis and clinical recurrence. Dilation seems particularly effective after EST, when this technique has failed.
基于对食管肌肉层的已知坏死作用，油酸乙醇胺（EO）内镜下硬化疗法（EST）被提议用于治疗贲门失弛缓症。本研究旨在评估 EST 的长期疗效。
20 年来，我们根据不同方案，连续对 4 组贲门失弛缓症患者进行了 EO 或聚多卡醇（PD）治疗。主要结果是吞咽困难缓解。次要结果是食管下括约肌压力、食管造影、胃食管反流和内镜超声检查（EUS）。EST 治疗无反应的患者接受 30mm 扩张治疗。
共有 103 例患者完成了治疗。在中期评估中，75 例完成治疗的患者达到了临床反应良好的标准，23 例为中等，5 例为失败。EUS 已成为指导治疗的非常有用的工具。总体随访时间为 87.9±66.7 个月。12 例患者出现迟发性失败。50 个月时，EO 的无复发累积预期率为 90%，但 PD 仅为 65%。接受挽救措施的患者在剩余随访期间仍保持良好或中等临床状况。年轻、PD 和食管造影上所谓的梭形模式是预后不良的显著预测因素。
EO 内镜下硬化疗法是贲门失弛缓症经典治疗方法的一种有前途的替代方法。相比之下，PD 治疗的患者表现出明显的纤维化和临床复发趋势。当 EST 治疗失败时，扩张似乎特别有效。
