Hernández-Mondragón O V, Solórzano-Pineda O M, González-Martínez M A, Blancas-Valencia J M, Caballero-Luengas C
Departamento de Endoscopia, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Departamento de Endoscopia Gastrointestinal, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México.
Rev Gastroenterol Mex (Engl Ed). 2019 Jan-Mar;84(1):1-10. doi: 10.1016/j.rgmx.2017.09.001. Epub 2018 Feb 26.
Achalasia is characterized by the absence of lower esophageal sphincter relaxation and esophageal aperistalsis. Diagnosis is confirmed through high-resolution esophageal manometry. Laparoscopic myotomy is the standard treatment, but peroral endoscopic myotomy (POEM) is a safe and effective alternative, with good short-term and medium-term results. Our aim was to describe the short-term and medium-term experience with POEM at a tertiary care center.
The study was conducted within the time frame of November 2014 and February 2017. Treatment-naïve achalasia patients and previously-treated achalasia patients that were candidates for POEM were included. A protocolized 24-month follow-up was carried out.
Fifty procedures were included and 31 (68%) were performed on women. Forty-one (82%) of the procedures were carried out on previously untreated patients, 7 (14%) were performed on previously treated patients, and 2 (4%) of the patients had redo-POEM. The mean age of the patients was 48.8±14.1 years. The pre-POEM Eckardt score was 9 and the integrated relaxation pressure was 24.4mmHg. Sixty-eight percent of the patients had type ii achalasia. Procedure time was 80min and myotomy length was 12.6cm. Hospital stay was 3 days and subcutaneous emphysema was the most common adverse event (30%). A total of 22/50 (44%) patients reached the 24-month follow-up, maintaining the Eckardt score and the decrease in the integrated relaxation pressure. There were no deaths. A total of 47.5% of the patients had a positive pH-study at 6 months, 15% had clinical reflux, and 35% presented with mild esophagitis. All the patients were adequately controlled with proton pump inhibitors.
POEM is safe and effective in the short term and medium term for the treatment of achalasia and other esophageal motor disorders in Mexican patients.
贲门失弛缓症的特征是食管下括约肌松弛缺失和食管无蠕动。通过高分辨率食管测压确诊。腹腔镜肌切开术是标准治疗方法，但经口内镜下肌切开术（POEM）是一种安全有效的替代方法，具有良好的短期和中期效果。我们的目的是描述一家三级医疗中心POEM的短期和中期经验。
该研究在2014年11月至2017年2月期间进行。纳入未经治疗的贲门失弛缓症患者以及适合POEM治疗的曾接受过治疗的贲门失弛缓症患者。进行了为期24个月的标准化随访。
共纳入50例手术，其中31例（68%）为女性。41例（82%）手术针对未经治疗的患者，7例（14%）针对曾接受过治疗的患者，2例（4%）患者进行了再次POEM手术。患者的平均年龄为48.8±14.1岁。POEM术前埃卡德特评分为9分，综合松弛压为24.4mmHg。68%的患者为Ⅱ型贲门失弛缓症。手术时间为80分钟，肌切开长度为12.6厘米。住院时间为3天，皮下气肿是最常见的不良事件（30%）。共有22/50（44%）患者完成了24个月的随访，埃卡德特评分维持不变，综合松弛压下降。无死亡病例。共有47.5%的患者在6个月时pH值研究呈阳性，15%有临床反流，35%有轻度食管炎。所有患者使用质子泵抑制剂均得到充分控制。
POEM在短期和中期治疗墨西哥患者的贲门失弛缓症及其他食管运动障碍方面是安全有效的。
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