Benedict Jacob J, Golas Adam A, Richter Joel E, Velanovich Vic
1 Division of General Surgery, University of South Florida Morsani College of Medicine , Tampa, Florida.
2 Division of Gastroenterology, University of South Florida Morsani College of Medicine , Tampa, Florida.
J Laparoendosc Adv Surg Tech A. 2017 Aug;27(8):778-783. doi: 10.1089/lap.2017.0087. Epub 2017 Jun 28.
Peroral endoscopic myotomy (POEM) has gained acceptance as a treatment for achalasia. The aim of this study was to assess symptomatic, quality of life (QoL), and physiological outcomes of POEM using standardized methods.
Patients who were planned to undergo POEM were evaluated pre- and postoperatively with timed barium esophagogram (TBE), high-resolution manometry (HRM), the achalasia symptom questionnaire (ASQ) (best score 10, worst score 31), and the short form (SF)-36 (best score 100, worst score 0). Nine patients completed postoperative HRM, TBE, and 48 hours esophageal pH monitoring. A P-value of <.05 was considered statistically significant.
A total of 34 of 37 patients completed the POEM procedure. There was improvement in the ASQ scores and in QoL. HRM integrated relaxation pressures (IRPs) improved from 31.4 ± 10.8 mmHg preoperatively to 12.3 ± 6.7 mmHg postoperatively, and lower esophageal sphincter pressure (LESP) improved from 49.1 ± 16.9 mmHg preoperatively to 23.1 ± 9.4 mmHg postoperatively. Of the 7 patients who were evaluated with 48-hour pH monitoring postoperatively, 5 patients (71%) demonstrated pathological reflux with an average Demeester score of 23.1 ± 19.1. There was a negative linear correlation between LESP change and Demeester scores (r = -0.7, P = .03).
The POEM procedure significantly improves achalasia-related symptoms and improves social functioning. Physiologically, there is reduction in both IRP and LESP. Postoperative pathological reflux is correlated with LESP reduction.
经口内镜下肌切开术（POEM）已被认可为治疗贲门失弛缓症的一种方法。本研究的目的是使用标准化方法评估POEM的症状、生活质量（QoL）和生理结果。
计划接受POEM的患者在术前和术后接受定时钡餐食管造影（TBE）、高分辨率测压（HRM）、贲门失弛缓症症状问卷（ASQ）（最佳分数10分，最差分数31分）和简短健康调查问卷（SF-36）（最佳分数100分，最差分数0分）评估。9例患者完成了术后HRM、TBE和48小时食管pH监测。P值<.05被认为具有统计学意义。
37例患者中有34例完成了POEM手术。ASQ评分和生活质量均有改善。HRM综合松弛压（IRP）从术前的31.4±10.8mmHg改善至术后的12.3±6.7mmHg，食管下括约肌压力（LESP）从术前的49.1±16.9mmHg改善至术后的23.1±9.4mmHg。在术后接受48小时pH监测的7例患者中，5例（71%）出现病理性反流，平均Demeester评分为23.1±19.1。LESP变化与Demeester评分之间存在负线性相关（r=-0.7，P=.03）。
POEM手术显著改善了贲门失弛缓症相关症状并改善了社会功能。在生理上，IRP和LESP均降低。术后病理性反流与LESP降低相关。
