Department of Hepatogastroenterology, IKEM, Videnska 1958/9, 140 21, Prague 4, Czech Republic.
2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
Surg Endosc. 2018 Jan;32(1):300-306. doi: 10.1007/s00464-017-5677-8. Epub 2017 Jun 27.
Peroral endoscopic myotomy (POEM) is an evolving therapeutic modality for achalasia. According to the original Inoue's technique, a submucosal lavage with gentamicin has been practiced due to the fear of infection. This single-tertiary center study was intended to assess the clinical significance of the topical antibiotic lavage during POEM.
A retrospective analysis of prospectively collected data was conducted. The outcomes of patients who received the gentamicin lavage (group A) during POEM were compared to those who did not (group B). The main outcome variables were infectious adverse events, post-POEM fever, and markers of systemic inflammatory response. One day before and after POEM, all patients received systemic antibiotic prophylaxis with ceftriaxone.
Of 124 consecutive patients having undergone POEM, 60 patients received a lavage with 80 mg of gentamicin into the submucosal tunnel before starting the myotomy, while 64 patients did not. The overall treatment success at 3 months did not differ between the two groups (group A 94.7 vs. 97.5% group B). We did not experience any significant infectious adverse events in either group. CRP and WBC levels were lower in patients with lavage versus those without [CRP: median 52.7 (IQR 34.9) vs. 69.5 (54.1); p = 0.01; WBCs: median 10.9 (IQR 3.3) vs. 12.6 (3.9); p < 0.01]. Post-procedural fever was present in 10% of patients in either group.
During POEM, the submucosal lavage with gentamicin prior to the myotomy does not play a role in the prevention of clinically significant infectious adverse events, although the systemic inflammatory response may be decreased.
经口内镜下肌切开术（POEM）是治疗贲门失弛缓症的一种新兴治疗方法。根据最初的 Inoue 技术，由于担心感染，在 POEM 中进行黏膜下灌洗时会使用庆大霉素。本单中心研究旨在评估 POEM 过程中局部使用抗生素灌洗的临床意义。
对前瞻性收集的数据进行回顾性分析。比较了在 POEM 过程中接受庆大霉素灌洗（A 组）和未接受灌洗（B 组）的患者的结局。主要观察变量为感染性不良事件、POEM 后发热和全身炎症反应标志物。所有患者在 POEM 前一天和后一天均接受头孢曲松全身抗生素预防。
在 124 例连续接受 POEM 的患者中，60 例在开始肌切开前用 80mg 庆大霉素向黏膜下隧道内灌洗，64 例未灌洗。两组患者在 3 个月时的总体治疗成功率无差异（A 组 94.7% vs. B 组 97.5%）。两组均未发生明显的感染性不良事件。灌洗组的 CRP 和 WBC 水平低于未灌洗组[CRP：中位数 52.7（IQR 34.9）vs. 69.5（54.1）；p=0.01；WBCs：中位数 10.9（IQR 3.3）vs. 12.6（3.9）；p<0.01]。两组中均有 10%的患者术后出现发热。
在 POEM 中，肌切开前黏膜下用庆大霉素灌洗并不能预防临床上有意义的感染性不良事件，尽管全身炎症反应可能会降低。
