Lu Bin, Li Meng, Hu Yue, Xu Yi, Zhang Shuo, Cai Li-Jun
Bin Lu, Meng Li, Yue Hu, Yi Xu, Shuo Zhang, Li-Jun Cai, Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China.
World J Gastroenterol. 2015 May 14;21(18):5622-9. doi: 10.3748/wjg.v21.i18.5622.
To assess the safety and feasibility of peroral esophageal myotomy (POEM) in patients with achalasia.
From January 2012 to March 2014, 50 patients (28 men, 22 women; mean age: 42.8 years, range: 14-70 years) underwent POEM. Pre- and postoperative symptoms were quantified using the Eckardt scoring system. Barium swallow and esophagogastroscopy were performed before and after POEM, respectively. Esophageal motility was evaluated in all patients, both preoperatively and one month after POEM treatment, using a high-resolution manometry system. Manometry data, Eckardt scores, lower esophageal sphincter pressure and barium swallow results were used to evaluate the effect of the procedure.
POEM was successfully completed for all patients. The mean procedure time was 55.4 ± 17.3 min and the mean total length of myotomy of the circular esophagus was 10.5 ± 2.6 cm. No specific complications occurred, with the exception of two patients that developed asymptomatic pneumomediastinum and subcutaneous emphysema. Clinical improvement in symptoms was achieved in all patients. Approximately 77.5% of patients experienced weight gain 6 mo after POEM, with an average of 4.78 kg (range: 2-15 kg). The lower esophageal sphincter resting pressure, four second integrated relaxation pressure and Eckardt scores were all significantly reduced after POEM (Ps < 0.05). A small segment of proximal esophageal peristalsis appeared postoperatively in two patients, but without normal esophageal peristalsis. The average diameter of the esophageal lumen decreased significantly from 4.39 to 3.09 cm (P < 0.01).
POEM can relieve achalasia symptoms, improve gastroesophageal junction relaxation and restore esophageal body motility function, but not normal esophageal peristalsis.
评估经口食管肌层切开术（POEM）治疗贲门失弛缓症患者的安全性和可行性。
2012年1月至2014年3月，50例患者（28例男性，22例女性；平均年龄：42.8岁，范围：14 - 70岁）接受了POEM治疗。术前和术后症状采用埃卡德特评分系统进行量化。POEM术前和术后分别进行了吞钡检查和食管胃镜检查。所有患者在术前和POEM治疗后1个月均使用高分辨率测压系统评估食管动力。测压数据、埃卡德特评分、食管下括约肌压力和吞钡检查结果用于评估该手术的效果。
所有患者的POEM均成功完成。平均手术时间为55.4±17.3分钟，食管环形肌层切开术的平均总长度为10.5±2.6厘米。除2例患者出现无症状性纵隔气肿和皮下气肿外，未发生其他特定并发症。所有患者的症状均有临床改善。约77.5%的患者在POEM术后6个月体重增加，平均增加4.78千克（范围：2 - 15千克）。POEM术后食管下括约肌静息压力、4秒综合松弛压力和埃卡德特评分均显著降低（P<0.05）。2例患者术后出现一小段近端食管蠕动，但无正常食管蠕动。食管腔平均直径从4.39厘米显著减小至3.09厘米（P<0.01）。
POEM可缓解贲门失弛缓症症状，改善胃食管交界处松弛并恢复食管体部动力功能，但不能恢复正常食管蠕动。
