S093：经肌切开术后治疗贲门失弛缓症复发症状的气囊扩张。
S093: pneumatic balloon dilation for palliation of recurrent symptoms of achalasia after esophagomyotomy.
机构信息
Division of General Surgery, Department of Surgery, Queen Elizabeth II Hospital, Dalhousie University, Victoria Campus, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital, Dalhousie University, Victoria Campus, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
出版信息
Surg Endosc. 2018 Sep;32(9):4017-4021. doi: 10.1007/s00464-018-6271-4. Epub 2018 Jun 15.
BACKGROUND
Achalasia is a chronic disease affecting the myenteric plexus of the esophagus and lower esophageal sphincter. Treatment is aimed at palliating symptoms to improve quality of life. Treatment options for symptom relapse after esophagomyotomy include botox injection, repeat myotomy, per-oral endoscopic myotomy, or pneumatic balloon dilation (PBD). Data demonstrating the safety and efficacy of PBD for recurrence are scarce. With a lack of published data, guidelines have suggested avoiding PBD for recurrent achalasia because of concern for a high risk of perforation.
METHODS
A retrospective review of patients who underwent PBD for recurrent symptoms of achalasia after esophagomyotomy between 2007 and 2017 was conducted. PBD was performed at 30 mm and held for 60 s under fluoroscopic guidance. Patients with residual symptoms had subsequent dilations at increasing 5 mm increments to a maximum of 40 mm. Patient demographics, Eckardt scores, presence of hiatal hernia, time from myotomy to recurrence, and diagnostic modalities were reported. The primary outcome was need for further endoscopic or surgical intervention. Complications are reported as secondary outcomes.
RESULTS
One-hundred eight esophagomyotomies were done during the study period. Fourteen patients underwent PBD for recurrent symptoms. The median time to symptom recurrence after esophagomyotomy was 28 months. The median Eckardt score was 6. Ten of 14 patients had an intervention between the initial surgery and PBD (9 standard dilations and 1 botox injection). A total of 23 PBD were done. Seven patients required dilation at 35 mm and two patients required dilation at 40 mm. Eleven patients required no further intervention at a median follow-up of 27.7 months. There were three treatment failures: one required repeat esophagomyotomy and two had no further treatments. There were no periprocedural complications.
CONCLUSION
Serial PBD is safe and effective in treatment of recurrent symptoms of achalasia after esophagomyotomy.
背景
贲门失弛缓症是一种影响食管肌间神经丛和食管下括约肌的慢性疾病。治疗旨在缓解症状，提高生活质量。食管肌切开术后症状复发的治疗选择包括肉毒杆菌毒素注射、重复肌切开术、经口内镜肌切开术或气动球囊扩张术（PBD）。关于 PBD 治疗复发的安全性和有效性的数据很少。由于担心穿孔风险高，缺乏已发表的数据，指南建议避免对复发性贲门失弛缓症行 PBD。
方法
对 2007 年至 2017 年间因食管肌切开术后复发症状而行 PBD 的患者进行回顾性研究。在透视引导下，将 PBD 施于 30mm 处并保持 60s。对仍有症状的患者，每次增加 5mm 直至最大 40mm 进行后续扩张。报告患者的人口统计学特征、Eckardt 评分、是否存在食管裂孔疝、肌切开术至复发的时间以及诊断方式。主要结局是是否需要进一步的内镜或手术干预。将并发症作为次要结局报告。
结果
研究期间共进行了 108 例食管肌切开术。14 例患者因复发症状而行 PBD。从食管肌切开术后到症状复发的中位时间为 28 个月。Eckardt 评分为 6 的患者有 10 例。在初始手术和 PBD 之间，14 例患者中有 11 例（9 例标准扩张和 1 例肉毒杆菌毒素注射）进行了干预。共进行了 23 次 PBD。7 例患者需扩张至 35mm，2 例患者需扩张至 40mm。11 例患者在中位随访 27.7 个月后无需进一步干预。有 3 例治疗失败：1 例需再次行食管肌切开术，2 例未再接受治疗。无围手术期并发症。
结论
在食管肌切开术后复发的贲门失弛缓症患者中，连续行 PBD 安全且有效。
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