经测压亚型分类的贲门失弛缓症经口内镜肌切开术结局比较。
Comparison of the Outcomes of Peroral Endoscopic Myotomy for Achalasia According to Manometric Subtype.
机构信息
Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea.
出版信息
Gut Liver. 2017 Sep 15;11(5):642-647. doi: 10.5009/gnl16545.
BACKGROUND/AIMS: We evaluated whether manometric subtype is associated with treatment outcome in patients with achalasia treated by peroral endoscopic myotomy (POEM).
METHODS
High-resolution manometry data and Eckardt scores were collected from 83 cases at two tertiary referral centers where POEM is performed. Manometric tracings were classified according to the three Chicago subtypes.
RESULTS
Among the 83 cases, 48 type I, 24 type II, and 11 type III achalasia cases were identified. No difference was found in pre-POEM Eckardt score, basal lower esophageal sphincter (LES) pressure, or integrated relaxation pressure (IRP) among the type I, type II, and type III groups. All three patient groups showed a significant improvement in post-POEM Eckardt score (6.1±2.1 to 1.5±1.5, p=0.001; 6.8±2.2 to 1.2±0.9, p=0.001; 6.6±2.0 to 1.6±1.4, p=0.011), LES pressure (26.1±13.8 to 15.4±6.8, p=0.018; 32.3±19.0 to 19.2±10.4, p=0.003; 36.8±19.2 to 17.5±9.7, p=0.041), and 4s IRP (21.5±11.7 to 12.0±8.7, p=0.007; 24.5±14.8 to 12.0±7.6, p=0.002; 24.0±15.7 to 11.8±7.1, p=0.019) at a median follow-up of 16 months.
CONCLUSIONS
POEM resulted in a good clinical outcome for all manometric subtypes.
背景/目的：我们评估了经口内镜肌切开术（POEM）治疗贲门失弛缓症患者的测压亚型与治疗结果是否相关。
方法
在两个开展 POEM 的三级转诊中心收集了 83 例患者的高分辨率测压数据和 Eckardt 评分。根据芝加哥三种分型对测压图进行分类。
结果
83 例患者中，48 例为 I 型，24 例为 II 型，11 例为 III 型。I 型、II 型和 III 型组之间，术前 Eckardt 评分、基础食管下括约肌（LES）压力和整体松弛压力（IRP）均无差异。三组患者 POEM 术后的 Eckardt 评分（6.1±2.1 至 1.5±1.5，p=0.001；6.8±2.2 至 1.2±0.9，p=0.001；6.6±2.0 至 1.6±1.4，p=0.011）、LES 压力（26.1±13.8 至 15.4±6.8，p=0.018；32.3±19.0 至 19.2±10.4，p=0.003；36.8±19.2 至 17.5±9.7，p=0.041）和 4s IRP（21.5±11.7 至 12.0±8.7，p=0.007；24.5±14.8 至 12.0±7.6，p=0.002；24.0±15.7 至 11.8±7.1，p=0.019）在中位随访 16 个月时均显著改善。
结论
POEM 治疗所有测压亚型均取得了良好的临床效果。
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