Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
J Am Coll Surg. 2013 Sep;217(3):442-51. doi: 10.1016/j.jamcollsurg.2013.04.033. Epub 2013 Jul 25.
A circular muscle myotomy preserving the longitudinal outer esophageal muscular layer is often recommended during peroral endoscopic myotomy (POEM) for achalasia. However, because the longitudinal muscle fibers of the esophagus are extremely thin and fragile, and completeness of myotomy is the basis for the excellent results of conventional surgical myotomy, this modification needs to be further debated. Here, we retrospectively analyzed our prospectively maintained POEM database to compare the outcomes of endoscopic full-thickness and circular muscle myotomy.
According to the myotomy depth, 103 patients with full-thickness myotomy were assigned to group A, while 131 patients with circular muscle myotomy were assigned to group B. Symptom relief, procedure-related parameters and adverse events, manometry outcomes, and reflux complications were compared between groups.
The mean operation times were significantly shorter in group A compared with group B (p = 0.02). There was no increase in any procedure-related adverse event after full-thickness myotomy (all p < 0.05). During follow-up, treatment success (Eckardt score ≤ 3) persisted for 96.0% (95 of 99) of patients in group A and for 95.0% (115 of 121) of patients in group B (p = 0.75). There were no statistically significant differences in pre- and post-treatment D-value of symptom scores and lower esophageal sphincter pressures between groups (both p > 0.05). The overall clinical reflux complication rates were also similar (21.2% vs 16.5%, p = 0.38).
Short-term symptom relief and manometry outcomes of each method were comparable. Full-thickness myotomy significantly reduced the procedure time but did not increase the procedure-related adverse events or clinical reflux complications.
在经口内镜肌切开术（POEM）治疗贲门失弛缓症时，通常建议保留食管外纵行肌层的环形肌切开术。然而，由于食管的纵行肌纤维极薄且脆弱，且全层肌切开术的完整性是常规手术肌切开术获得良好效果的基础，因此需要进一步讨论这种改良方法。在这里，我们回顾性分析了我们前瞻性维护的 POEM 数据库，以比较内镜全层和环形肌切开术的结果。
根据切开深度，103 例全层切开术患者被分配至 A 组，131 例行环形肌切开术患者被分配至 B 组。比较两组间症状缓解、与操作相关的参数和不良事件、测压结果和反流并发症。
A 组的平均手术时间明显短于 B 组（p = 0.02）。全层切开术后，与操作相关的任何不良事件均无增加（均 p < 0.05）。在随访期间，A 组 96.0%（99 例中的 95 例）和 B 组 95.0%（121 例中的 115 例）的患者治疗成功率（Eckardt 评分≤3）持续存在（p = 0.75）。两组间症状评分和食管下括约肌压力的 D 值在治疗前后均无统计学差异（均 p > 0.05）。总体临床反流并发症发生率也相似（21.2% vs 16.5%，p = 0.38）。
两种方法的短期症状缓解和测压结果相当。全层肌切开术显著缩短了手术时间，但并未增加与操作相关的不良事件或临床反流并发症。
