Guo H, Yang H, Zhang X, Wang L, Lv Y, Zou X, Ling T
Dis Esophagus. 2017 May 1;30(5):1-6. doi: 10.1093/dote/dow011.
Peroral endoscopic myotomy (POEM) has been widely applied to the treatment of achalasia. The aim of this study is to retrospectively investigate the long-term outcome of POEM in patients with achalasia. Patients undergoing POEM at our center with a minimum follow-up of 3 years were enrolled in this study. Relief of patients' symptom was defined as the primary outcome. Secondary outcomes included lower esophageal sphincter pressure, esophageal emptying, symptoms relapse, and clinical reflux adverse events. The Chi-square test was performed to determine the potential predictors of surgical failure. Sixty-seven patients (aged 40.7 ± 15.3 years) were recruited in the study, with a mean follow-up period of 40.1 ± 2.8 months. At the final follow-up, the median Eckardt score reduced from 7.6 ± 2.3 preoperatively to 1.9 ± 1.7 (P < 0.001), the lower esophageal sphincter pressure was reduced from 35.4 ± 13.7 mmHg preoperatively to 8.9 ± 4.1 mmHg (P < 0.001), and the height of the barium column at 5 min after barium swallowed was reduced from 9.7 ± 1.6 cm preoperatively to 2.9 ± 2.1 cm (P < 0.001). Eight patients had symptoms relapse and nine patients developed reflux esophagitis. Type III achalasia was found to be indicative of surgical failure. POEM was a promising treatment for patients with achalasia, which can yield a long-term relief of the symptom and a low rate of clinical reflux adverse events.
经口内镜下肌切开术（POEM）已广泛应用于贲门失弛缓症的治疗。本研究旨在回顾性调查POEM治疗贲门失弛缓症患者的长期疗效。在我们中心接受POEM治疗且随访至少3年的患者纳入本研究。患者症状缓解被定义为主要结局。次要结局包括食管下括约肌压力、食管排空、症状复发及临床反流不良事件。采用卡方检验确定手术失败的潜在预测因素。本研究共纳入67例患者（年龄40.7±15.3岁），平均随访时间为40.1±2.8个月。末次随访时，Eckardt评分中位数从术前的7.6±2.3降至1.9±1.7（P<0.001），食管下括约肌压力从术前的35.4±13.7 mmHg降至8.9±4.1 mmHg（P<0.001），吞钡后5分钟钡柱高度从术前的9.7±1.6 cm降至2.9±2.1 cm（P<0.001）。8例患者症状复发，9例患者发生反流性食管炎。发现III型贲门失弛缓症提示手术失败。POEM是治疗贲门失弛缓症患者的一种有前景的治疗方法，可实现症状的长期缓解且临床反流不良事件发生率低。
