Wang J, Tan N, Xiao Y, Chen J, Chen B, Ma Z, Zhang D, Chen M, Cui Y
Department of Gastroenterology and Hepatology, and Endoscopy Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Digestive Department, Shantou Central Hospital, Shantou, Guangdong, China.
Dis Esophagus. 2015 Nov-Dec;28(8):720-7. doi: 10.1111/dote.12280. Epub 2014 Sep 12.
Peroral endoscopic myotomy (POEM) has been developed as a minimally invasive endoscopic treatment for achalasia for years. However, the optimal length of submucosal tunnel and myotomy of muscle bundles during procedure of POEM has not yet been determined, so we aim to assess safety and efficacy of modified POEM with shorter myotomy of muscle bundles in achalasia patients. Consecutive achalasia patients had been performed modified POEM with shorter myotomy, and assessed by symptoms, high-resolution manometry, and barium swallow examinations before and 3 months after POEM for safety and efficacy evaluation. Modified POEM with shorter submucosal tunnel (mean length 6.8 cm) and endoscopic myotomy of muscle bundles (total mean length 5.4 cm) were completed in 46 consecutive achalasia patients. During the 3-month follow up in all cases, significant improvement of symptoms (a significant drop in the Eckardt score 8.4 ± 3.2 vs. 2.7 ± 1.9; P < 0.001), decreased lower esophageal sphincter pressure (39.4 ± 10.1 vs. 24.4 ± 9.1 mmHg; P < 0.001) and integrated relaxation pressure (38.6 ± 10.4 vs. 25.7 ± 9.6 mmHg; P < 0.01), and a drop in height of esophagus barium-contrast column (5.4 ± 3.1 vs. 2.6 ± 1.8 cm; P < 0.001) were observed. The frequencies of adverse events were lower in those under endotracheal anesthesia and CO2 insufflations compared with intravenous anesthesia and air insufflations. Only three patients were found to have gastroesophageal reflux disease on follow up. Modified POEM with shorter myotomy under endotracheal anesthesia and CO2 insufflations shows its good safety and excellent short-term efficacy in the treatment of achalasia. But further studies are warranted to assess the long-term efficacy.
多年来，经口内镜下肌切开术（POEM）已发展成为一种用于治疗贲门失弛缓症的微创内镜治疗方法。然而，POEM手术过程中黏膜下隧道和肌束肌切开术的最佳长度尚未确定，因此我们旨在评估在贲门失弛缓症患者中采用较短肌束肌切开术的改良POEM的安全性和有效性。对连续的贲门失弛缓症患者进行了采用较短肌切开术的改良POEM，并在POEM术前和术后3个月通过症状、高分辨率测压和吞钡检查进行评估，以评价安全性和有效性。46例连续的贲门失弛缓症患者完成了较短黏膜下隧道（平均长度6.8 cm）和肌束内镜下肌切开术（总平均长度5.4 cm）的改良POEM。在所有病例的3个月随访期间，症状有显著改善（ Eckardt评分显著下降，从8.4±3.2降至2.7±1.9；P<0.001），食管下括约肌压力降低（从39.4±10.1降至24.4±9.1 mmHg；P<0.001）以及综合松弛压降低（从38.6±10.4降至25.7±9.6 mmHg；P<0.01），并且食管钡剂造影柱高度下降（从5.4±3.1降至2.6±1.8 cm；P<0.001）。与静脉麻醉和空气充气相比，气管内麻醉和二氧化碳充气患者的不良事件发生率较低。随访中仅发现3例患者患有胃食管反流病。气管内麻醉和二氧化碳充气下采用较短肌切开术的改良POEM在治疗贲门失弛缓症方面显示出良好的安全性和出色的短期疗效。但需要进一步研究来评估其长期疗效。
