Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
Department of Endoscopy, Kobe University Hospital, Kobe, Japan.
Dig Endosc. 2018 Mar;30(2):206-211. doi: 10.1111/den.12957. Epub 2017 Oct 12.
One of the challenges during peroral endoscopic myotomy (POEM) is ensuring the appropriate length of myotomy on the gastric side. To determine the appropriate distal end of the gastric myotomy, we focused on the two penetrating vessels (TPVs) found in the gastric cardia during POEM. In the present study, we evaluated whether the TPVs could serve as an accurate indicator of the appropriate distal end of the gastric myotomy.
All patients who underwent POEM between March and August 2016 were included for this study. When making the submucosal tunnel in the 5 o'clock direction into the stomach, two vessels penetrating through the circular muscle along the edge of oblique muscle in the cardia can be exposed. We designated these two vessels as TPVs. The myotomy was extended until the second TPVs was exposed. The anal end of the submucosal tunnel was confirmed by the double-scope POEM technique, and the length from the gastroesophageal junction to the anal side end of the myotomy was measured by the scale on the endoscope.
Among 37 patients who underwent myotomy in the 5 o'clock position, TPVs were found in 34 patients (91.2%). Sufficient submucosal tunneling on the gastric side was confirmed by the double-scope POEM technique in these 34 patients. Median length of the gastric myotomy was 3.0 cm (range 2-4 cm).
TPVs appears to be a simple and reliable indicator to determine the appropriate distal end of myotomy.
经口内镜下肌切开术（POEM）过程中的一个挑战是确保胃侧肌切开的适当长度。为了确定胃切开术的适当远端终点，我们在 POEM 期间关注胃贲门处发现的两个穿透血管（TPV）。在本研究中，我们评估了 TPV 是否可以作为胃切开术适当远端终点的准确指标。
本研究纳入了 2016 年 3 月至 8 月间接受 POEM 的所有患者。当在 5 点钟方向向胃内建立黏膜下隧道时，可以暴露两个穿透环形肌并沿着贲门斜肌边缘的血管。我们将这两个血管指定为 TPV。将肌切开术延长至暴露第二个 TPV。通过双镜 POEM 技术确认黏膜下隧道的肛门端，并用内镜上的标尺测量从食管胃交界到肌切开术肛门侧端的长度。
在 37 例接受 5 点钟位置肌切开术的患者中，34 例（91.2%）发现 TPV。这 34 例患者均通过双镜 POEM 技术确认了足够的胃侧黏膜下隧道。胃切开术的中位长度为 3.0cm（范围 2-4cm）。
TPV 似乎是确定肌切开术适当远端终点的一种简单可靠的指标。
