Teitelbaum Ezra N, Soper Nathaniel J, Santos Byron F, Arafat Fahd O, Pandolfino John E, Kahrilas Peter J, Hirano Ikuo, Hungness Eric S
Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Chicago, IL, 60611, USA,
Surg Endosc. 2014 Dec;28(12):3359-65. doi: 10.1007/s00464-014-3628-1. Epub 2014 Jun 18.
Peroral esophageal myotomy (POEM) is a new endoscopic operation for the treatment of achalasia. Here, we report 1-year physiologic and symptomatic outcomes following the procedure.
POEM patients from a single-institution series who were more than 1 year removed from surgery were studied. Eckardt and GerdQ scores were obtained to assess symptoms. High-resolution manometry (HRM), timed barium esophagram (TBE), and upper endoscopy were preformed preoperatively and at 1-year follow-up. 24-h pH monitoring was also performed at 1 year follow-up.
The study population was comprised of 41 patients who were more than 1 year post-POEM. One (2%) major complication, a contained leak at the EGJ requiring re-operation, and 7 (17%) minor complications occurred. Mean length of stay was 1.4 days. At mean 15-month follow-up, Eckardt scores improved from pre-POEM 7 ± 2 to post-POEM 1 ± 2, (scale 0-12, p < .001), and 92% of patients achieved treatment success (Eckardt score <4). Two of the three treatment failures in the series occurred in the initial three patients. 15% of patients had post-POEM symptoms suggestive of gastroesophageal reflux (GerdQ >7). On follow-up HRM, esophagogastric junction integrated relaxation pressure was decreased significantly (pre-POEM 28 ± 12 mmHg vs. post-POEM 11 ± 4 mmHg, p < .001), and 47% of patients studied had partial recovery of peristalsis. On follow-up TBE, barium column heights were decreased compared with preoperatively. Postoperative upper endoscopy revealed esophagitis in 59% of patients (11 LA Grade A, 2 LA Grade D). However, of the 13 24-h pH monitoring studies performed, only four (31%) demonstrated pathologic esophageal acid exposure.
In this series, POEM resulted in greater than 90% symptomatic treatment success at mean 15-month follow-up. Rates of iatrogenic gastroesophageal reflux, as measured both by symptoms and 24-h pH monitoring, appeared to be on par with recent studies of patients undergoing laparoscopic Heller myotomy and pneumatic dilation.
经口食管肌层切开术（POEM）是一种治疗贲门失弛缓症的新型内镜手术。在此，我们报告该手术后1年的生理和症状学结果。
对来自单一机构系列研究中术后超过1年的POEM患者进行研究。获取埃卡德特（Eckardt）评分和胃食管反流病问卷（GerdQ）评分以评估症状。术前及术后1年随访时进行高分辨率测压（HRM）、定时食管钡餐造影（TBE）及上消化道内镜检查。术后1年随访时还进行24小时pH监测。
研究人群包括41例POEM术后超过1年的患者。发生1例（2%）严重并发症，即食管胃交界部局限性渗漏需再次手术，7例（17%）发生轻微并发症。平均住院时间为1.4天。平均15个月随访时，埃卡德特评分从POEM术前的7±2改善至术后的1±2（范围0 - 12，p <.001），92%的患者治疗成功（埃卡德特评分<4）。该系列中3例治疗失败患者中的2例出现在最初的3例患者中。15%的患者术后有提示胃食管反流的症状（GerdQ>7）。随访HRM显示，食管胃交界部综合松弛压显著降低（POEM术前28±12 mmHg vs.术后11±4 mmHg，p <.001），47%的研究患者蠕动部分恢复。随访TBE显示，与术前相比钡柱高度降低。术后上消化道内镜检查显示59%的患者有食管炎（11例洛杉矶分级A级，2例D级）。然而，在13例进行的24小时pH监测研究中，只有4例（31%）显示有病理性食管酸暴露。
在本系列研究中，POEM在平均15个月随访时症状治疗成功率超过90%。通过症状和24小时pH监测测量的医源性胃食管反流发生率似乎与近期腹腔镜海勒肌层切开术和气囊扩张术患者的研究结果相当。
