Johns Hopkins Medical Institute, Baltimore, Maryland, USA.
Showa University Northern Yokohama Hospital, Yokohama, Japan.
Gastrointest Endosc. 2015 May;81(5):1170-7. doi: 10.1016/j.gie.2014.10.011. Epub 2015 Jan 26.
Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophageal disorders (SEDs).
To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm, jackhammer esophagus, or type III (spastic) achalasia.
Retrospective study.
International, multicenter, academic institutions.
All patients who underwent POEM for treatment of SEDs refractory to medical therapy at 11 centers were included.
POEM.
Eckardt score and adverse events.
A total of 73 patients underwent POEM for treatment of SEDs (diffuse esophageal spasm 9, jackhammer esophagus 10, spastic achalasia 54). POEM was successfully completed in all patients, with a mean procedural time of 118 minutes. The mean length of the submucosal tunnel was 19 cm, and the mean myotomy length was 16 cm. A total of 8 adverse events (11%) occurred, with 5 rated as mild, 3 moderate, and 0 severe. The mean length of hospital stay was 3.4 days. There was a significant decrease in Eckardt scores after POEM (6.71 vs 1.13; P = .0001). Overall, clinical response was observed in 93% of patients during a mean follow-up of 234 days. Chest pain significantly improved in 87% of patients who reported chest pain before POEM. Repeat manometry after POEM was available in 44 patients and showed resolution of initial manometric abnormalities in all cases.
Retrospective design and selection bias.
POEM offers a logical therapeutic modality for patients with SEDs refractory to medical therapy. Results from this international study suggest POEM as an effective and safe platform for these patients.
关于经口内镜肌切开术（POEM）治疗痉挛性食管疾病（SEDs）的应用，目前仅有有限的数据。
研究 POEM 治疗弥漫性食管痉挛、“ hammer 食管”或 III 型（痉挛性）贲门失弛缓症的疗效和安全性。
回顾性研究。
国际、多中心、学术机构。
所有在 11 个中心因药物治疗无效而行 POEM 治疗 SED 的患者均被纳入。
POEM。
Eckardt 评分和不良事件。
共有 73 例患者因 SED 而行 POEM 治疗（弥漫性食管痉挛 9 例，“ hammer 食管” 10 例，痉挛性贲门失弛缓症 54 例）。所有患者均成功完成 POEM，平均手术时间为 118 分钟。黏膜下隧道的平均长度为 19cm，平均肌切开长度为 16cm。共发生 8 例（11%）不良事件，其中 5 例为轻度，3 例为中度，无严重不良事件。平均住院时间为 3.4 天。POEM 后 Eckardt 评分显著下降（6.71 分比 1.13 分；P =.0001）。平均随访 234 天期间，93%的患者临床症状得到缓解。87%的胸痛患者 POEM 后胸痛明显改善。44 例患者行重复测压，所有患者初始测压异常均得到缓解。
回顾性设计和选择偏倚。
POEM 为药物治疗无效的 SED 患者提供了一种合理的治疗方法。本国际研究结果表明 POEM 是此类患者有效且安全的治疗平台。
