Department of Gastroenterology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
J Dig Dis. 2014 Jul;15(7):352-8. doi: 10.1111/1751-2980.12153.
To investigate the outcomes of Chinese Han patients who underwent peroral endoscopic myotomy (POEM) for achalasia.
Patients undergoing POEM for achalasia at the Affiliated Drum Tower Hospital of Nanjing University Medical School were prospectively enrolled in this study, with a follow-up duration of at least one year. Their outcomes were evaluated by analyzing esophageal manometry, timed barium esophagogram and 36-Item Short Form Health Survey (SF-36), which were performed before surgery, 5 days after surgery and at the last follow-up. Patients' symptom relief was considered the primary outcome. Secondary outcomes included lower esophageal sphincter (LES) pressure, esophageal emptying, patients' quality of life (QoL) and procedure-related complications.
Eighty-seven patients were included in the study. Eckardt score after POEM was remarkably lower than the preoperative score (0.4 ± 0.7 vs 7.1 ± 2.1, P = 0.001). The preoperative LES pressure was 32.4 ± 15.3 mmHg, which was decreased to 3.8 ± 3.9 mmHg immediately after surgery. The height of the barium column at 1 min after barium swallow was significantly reduced after treatment (11.7 ± 1.2 cm vs 3.2 ± 1.6 cm, P < 0.001). The patients' QoL was also improved, as indicated by obviously increased physical and mental component summary (PCS and MCS) scores of the SF-36. Complications occurred during POEM included cutaneous emphysema, mucosal injury and pneumothorax.
POEM is an effective approach for treating achalasia, which can relieve the symptoms of achalasia by improving esophageal emptying and lowering LES pressure.
探讨经口内镜下肌切开术（POEM）治疗中国人贲门失弛缓症的疗效。
前瞻性收集南京大学医学院附属鼓楼医院行 POEM 治疗的贲门失弛缓症患者，随访时间至少 1 年。分析术前、术后 5 天及末次随访时食管测压、食管钡剂造影和 36 项简明健康调查问卷（SF-36），评价患者的疗效。症状缓解情况作为主要疗效指标，同时观察食管下括约肌（LES）压力、食管排空情况、患者生活质量（QoL）及手术相关并发症。
共纳入 87 例患者，POEM 术后 Eckardt 评分明显低于术前（0.4 ± 0.7 比 7.1 ± 2.1，P = 0.001）。术前 LES 压力为 32.4 ± 15.3 mmHg，术后即刻降为 3.8 ± 3.9 mmHg。钡剂吞咽后 1 min 时钡柱高度明显降低（11.7 ± 1.2 cm 比 3.2 ± 1.6 cm，P < 0.001）。SF-36 中的生理和心理评分明显升高，表明患者 QoL 得到改善。POEM 相关并发症包括皮下气肿、黏膜损伤和气胸。
POEM 治疗贲门失弛缓症安全有效，可通过改善食管排空和降低 LES 压力缓解症状。
