Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Gastrointest Endosc. 2018 Jan;87(1):95-101. doi: 10.1016/j.gie.2017.04.036. Epub 2017 May 3.
Per-oral endoscopic myotomy (POEM) has been rapidly gaining ground as a treatment for achalasia. Although POEM is a safe and effective treatment, a subset of patients has persistent or recurrent symptoms after POEM. This study aimed to examine the efficacy of different retreatments after failed POEM.
POEM was performed on 441 patients with achalasia at 3 tertiary-care hospitals between 2010 and 2015. A review of prospectively collected data was conducted. All patients with achalasia with significant persistent or recurrent symptoms within 3 years after POEM, defined as an Eckardt symptom score >3, were included.
Forty-three of 441 patients (9.8%) had persistent or recurrent symptoms after POEM, of which 34 (8%) received 1 or more retreatments. Retreatment with laparoscopic Heller myotomy and retreatment with POEM showed a modest efficacy of 45% and 63%, respectively, whereas pneumatic dilatation showed a poor efficacy of only 0% to 20%, depending on the size of the balloon. Male patients were more likely to have retreatment failure than female patients (P = .038).
In patients with achalasia with persistent or recurrent symptoms after failed POEM, retreatment with laparoscopic Heller myotomy or retreatment with POEM has a higher efficacy than retreatment with pneumatic dilatations. Failure of retreatment occurred more often in male patients.
经口内镜下肌切开术（POEM）作为贲门失弛缓症的一种治疗方法，已迅速得到认可。虽然 POEM 是一种安全有效的治疗方法，但一部分患者在 POEM 后仍存在持续性或复发性症状。本研究旨在探讨 POEM 失败后的不同治疗方法的疗效。
2010 年至 2015 年，在 3 家三级护理医院对 441 例贲门失弛缓症患者进行了 POEM。对前瞻性收集的数据进行了回顾。所有在 POEM 后 3 年内出现明显持续性或复发性症状的贲门失弛缓症患者（定义为 Eckardt 症状评分>3）均纳入本研究。
441 例患者中有 43 例（9.8%）POEM 后存在持续性或复发性症状，其中 34 例（8%）接受了 1 次或多次治疗。腹腔镜 Heller 肌切开术和 POEM 再治疗的疗效分别为 45%和 63%，而气囊扩张术的疗效仅为 0%至 20%，这取决于气囊的大小。男性患者的治疗失败率高于女性患者（P=.038）。
在 POEM 失败后出现持续性或复发性症状的贲门失弛缓症患者中，与气囊扩张术相比，腹腔镜 Heller 肌切开术或 POEM 再治疗的疗效更高。男性患者更易发生治疗失败。
