Department of General Surgery, University of Pennsylvania, Philadelphia, PA.
University of Pennsylvania School of Medicine, Philadelphia, PA.
J Am Coll Surg. 2018 Apr;226(4):465-472.e1. doi: 10.1016/j.jamcollsurg.2017.12.050. Epub 2018 Feb 2.
Although laparoscopic Heller myotomy (LHM) has been the standard of care for achalasia, per oral endoscopic myotomy (POEM) has gained popularity as a viable alternative. This retrospective study aimed to compare patient-reported outcomes between LHM and POEM in a consecutive series of achalasia patients with more than 1 year of follow-up.
We reviewed demographic and procedure-related data for patients who underwent either LHM or POEM for achalasia between January 2011 and May 2016. Phone interviews were conducted assessing post-procedure achalasia symptoms via the Eckardt score and achalasia severity questionnaire (ASQ). Demographics, disease factors, and survey results were compared between LHM and POEM patients using univariate analysis. Significant predictors of procedure failure were analyzed using univariate and multivariate analysis.
There were no serious complications in 110 consecutive patients who underwent LHM or POEM during the study period, and 96 (87%) patients completed phone surveys. There was a nonsignificant trend toward better patient-reported outcomes with POEM. There were significant differences in patient characteristics including sex, achalasia type, mean residual lower esophageal pressure (rLESP), and follow-up time. The only univariate predictors of an unsatisfactory Eckardt score or ASQ were longer follow-up and lower rLESP, with follow-up length being the only predictor on multivariate analysis.
There were significant demographic and clinical differences in patient selection for POEM vs LHM in our group. Although the 2 procedures have similar patient-reported effectiveness, subjective outcomes seem to decline as a result of time rather than procedure type.
虽然腹腔镜 Heller 肌切开术（LHM）一直是贲门失弛缓症的标准治疗方法，但经口内镜肌切开术（POEM）作为一种可行的替代方法已越来越受欢迎。本回顾性研究旨在对接受 LHM 或 POEM 治疗的贲门失弛缓症患者进行比较，这些患者的随访时间超过 1 年，并比较患者报告的结果。
我们回顾了 2011 年 1 月至 2016 年 5 月期间接受 LHM 或 POEM 治疗的贲门失弛缓症患者的人口统计学和手术相关数据。通过 Eckardt 评分和贲门失弛缓症严重程度问卷（ASQ）对术后贲门失弛缓症症状进行电话访谈。使用单变量分析比较 LHM 和 POEM 患者的人口统计学、疾病因素和调查结果。使用单变量和多变量分析分析手术失败的显著预测因素。
在研究期间，110 例连续接受 LHM 或 POEM 治疗的患者均无严重并发症，96 例（87%）患者完成了电话调查。POEM 的患者报告结果有更好的趋势。患者特征包括性别、贲门失弛缓症类型、平均残余食管下压力（rLESP）和随访时间存在显著差异。不满意的 Eckardt 评分或 ASQ 的唯一单变量预测因素是随访时间较长和 rLESP 较低，多变量分析中唯一的预测因素是随访时间。
在我们的研究中，POEM 与 LHM 患者的选择存在显著的人口统计学和临床差异。尽管这两种手术的患者报告效果相似，但主观结果似乎随着时间的推移而下降，而不是手术类型。
