Hu Jian-Wei, Li Quan-Lin, Zhou Ping-Hong, Yao Li-Qing, Xu Mei-Dong, Zhang Yi-Qun, Zhong Yun-Shi, Chen Wei-Feng, Ma Li-Li, Qin Wen-Zheng, Cai Ming-Yan
Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, China.
Surg Endosc. 2015 Sep;29(9):2841-50. doi: 10.1007/s00464-014-4013-9. Epub 2014 Dec 10.
The sigmoid-shaped esophagus is considered to be the advanced stage of achalasia, in which the esophageal lumen is significantly dilated, swerved, and rotated. In consideration of the efficacy of peroral endoscopic myotomy (POEM) for early achalasia, it may also offer another option for the treatment of advanced achalasia with sigmoid-shaped esophagus. Our purpose was to evaluate the feasibility and long-term efficacy of POEM for patients with sigmoid-type achalasia.
32 consecutive patients with sigmoid-type achalasia (S1 type in 29 patients and S2 type in 3 patients) were prospectively included. Primary outcome was symptom relief during follow-up, defined as an Eckardt score ≤3. Secondary outcomes were procedure-related adverse events, the resting lower esophageal sphincter (LES) pressure, clinical reflux complications, and procedure-related parameters.
All cases received POEM successfully. The mean operation time was 63.7 min (range 22-130 min). No serious complications related to POEM were encountered. During a mean follow-up period of 30.0 months (range 24-44 months), treatment success was achieved e in 96.8% of cases (mean score pre- vs. post-treatment 7.8 vs. 1.4; P < 0.001). Mean LES pressure also decreased from a mean of 37.9 to 12.9 mmHg after POEM (P < 0.001). One patient experienced only partial symptom relief and additional balloon dilations were carried out to relief the symptoms twice. The overall clinical reflux complication rate of POEM for sigmoid-type achalasia was 25.8%.
The 2-year outcomes of POEM for advanced achalasia with sigmoid-shaped esophagus were excellent, resulting in long-term symptom relief in over 96% cases and without serious complications. The morphological changes of esophagus may make subsequent endoscopic tunneling more challenging and time-consuming, but do not prevent successful POEM.
乙状结肠型食管被认为是贲门失弛缓症的晚期阶段，此时食管腔显著扩张、弯曲并旋转。考虑到经口内镜下肌切开术（POEM）对早期贲门失弛缓症的疗效，它可能也为乙状结肠型食管晚期贲门失弛缓症的治疗提供了另一种选择。我们的目的是评估POEM治疗乙状结肠型贲门失弛缓症患者的可行性和长期疗效。
前瞻性纳入32例连续的乙状结肠型贲门失弛缓症患者（29例为S1型，3例为S2型）。主要结局是随访期间症状缓解，定义为埃卡德特评分≤3分。次要结局是与手术相关的不良事件、静息下食管括约肌（LES）压力、临床反流并发症以及与手术相关的参数。
所有病例均成功接受POEM治疗。平均手术时间为63.7分钟（范围22 - 130分钟）。未遇到与POEM相关的严重并发症。在平均30.0个月（范围24 - 44个月）的随访期内，96.8%的病例治疗成功（治疗前平均评分7.8分，治疗后平均评分1.4分；P < 0.001）。POEM术后LES平均压力也从37.9 mmHg降至12.9 mmHg（P < 0.001）。1例患者仅部分症状缓解，随后进行了两次额外的球囊扩张以缓解症状。POEM治疗乙状结肠型贲门失弛缓症的总体临床反流并发症发生率为25.8%。
POEM治疗乙状结肠型食管晚期贲门失弛缓症的2年结局良好，超过96%的病例获得长期症状缓解且无严重并发症。食管的形态改变可能使后续内镜隧道操作更具挑战性和耗时，但并不妨碍POEM手术成功。
