Legros Ludivine, Ropert Alain, Brochard Charlène, Bouguen Guillaume, Pagenault Maël, Siproudhis Laurent, Bretagne Jean-François
Service des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Rennes, Rennes, France.
Neurogastroenterol Motil. 2014 Sep;26(9):1248-55. doi: 10.1111/nmo.12380. Epub 2014 Jun 11.
The aim of this study was to assess the efficacy and safety of pneumatic dilatation (PD) to treat symptom recurrence after Heller myotomy (HM).
Consecutive patients receiving PD for relapsing symptoms following prior HM were included in this retrospective single-center study. Eckardt score ≤3 and/or ∆ Eckardt (difference between Eckardt score before and after dilatation) ≥3 defined the success of initial dilatation. Patients who maintained response longer than 2 months after initial dilatation were defined as short-term responders. Relapsers were offered further on-demand dilatation. Remission was defined as an Eckardt score ≤3 at the study endpoint. Kaplan-Meier survival curves were used to determine relapse rates.
Eighteen patients (11 women, seven men) were included from January 2004 to January 2013. Ten patients had type I achalasia, and seven had type III, according to the Chicago classification. Thirty-nine PDs were performed (1.5 [1-2.25] per patient). All patients had short-term responses. The remission rate at the endpoint, after a median follow-up of 33 months, was 78%, but 44% were treated with on-demand PD during the follow-up interval. The proportions of patients without relapse and subsequent PD were 72% at 12 months, 65% at 24 and 36 months, and 49% at 48 months. No factors predictive of long-term response, particularly the type of achalasia, could be identified in this series. There were no perforations.
CONCLUSIONS & INFERENCES: In treating symptom recurrence following HM, PD was safe and effective over the long term when combined with subsequent PD.
本研究旨在评估气囊扩张术（PD）治疗贲门失弛缓症Heller肌切开术（HM）后症状复发的疗效和安全性。
本回顾性单中心研究纳入了因先前HM后症状复发而接受PD治疗的连续患者。Eckardt评分≤3和/或ΔEckardt（扩张前后Eckardt评分之差）≥3定义为初始扩张成功。初始扩张后维持反应超过2个月的患者定义为短期反应者。复发患者可接受按需扩张。缓解定义为研究终点时Eckardt评分≤3。采用Kaplan-Meier生存曲线确定复发率。
2004年1月至2013年1月共纳入18例患者（11例女性，7例男性）。根据芝加哥分类，10例为I型贲门失弛缓症，7例为III型。共进行了39次PD（每位患者1.5次[1 - 2.25次]）。所有患者均有短期反应。中位随访33个月后，终点时的缓解率为78%，但44%的患者在随访期间接受了按需PD治疗。12个月时无复发及后续未接受PD治疗的患者比例为72%，24个月和36个月时为65%，48个月时为49%。在本系列中未发现预测长期反应的因素，尤其是贲门失弛缓症的类型。无穿孔发生。
在治疗HM后症状复发时，PD联合后续按需PD长期来看是安全有效的。
