Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA.
Endoscopy. 2019 Apr;51(4):342-345. doi: 10.1055/a-0656-5530. Epub 2018 Aug 1.
The outcome of peroral endoscopic myotomy (POEM) in patients with prior Roux-en-Y gastric bypass (RYGB) is not known and some experts have recommended against its performance in this patient population because of the risk of postoperative regurgitation. The aim of this study was to report on the outcomes of POEM in patients with RYGB anatomy.
Patients with RYGB anatomy who underwent POEM for the treatment of achalasia at three tertiary centers were included. POEM was performed in standard fashion using the anterior or posterior approach. Clinical response was defined by a decrease in Eckardt score to ≤ 3. Results of esophageal acid exposure testing/pH-impedance and manometric testing after POEM were reported when available.
A total of 10 achalasia patients with prior RYGB surgery underwent POEM. All procedures were technically successful with anterior myotomy performed in seven patients. The mean submucosal tunnel length and myotomy length were 12.9 cm and 11.1 cm, respectively. The mean procedure time was 72 minutes and mean length of hospital stay was 1.5 days. Clinical success was achieved in all 10 patients with a significant decrease in Eckardt score from 6.5 to 1 ( < 0.001). None of the patients experienced post-procedural regurgitation. Post-procedural pH testing was obtained in six patients and was normal in all of them.
This study suggests the feasibility, safety, and efficacy of POEM in patients with prior RYGB surgery. The risk of gastroesophageal reflux disease in these patients seems to be minimal after POEM.
经口内镜下肌切开术（POEM）治疗 Roux-en-Y 胃旁路术（RYGB）后的患者的结果尚不清楚，一些专家建议在这种患者人群中避免进行 POEM，因为有术后反流的风险。本研究旨在报告 RYGB 解剖患者 POEM 的结果。
纳入在三个三级中心接受 POEM 治疗贲门失弛缓症的 RYGB 解剖患者。POEM 采用标准的前或后入路进行。临床反应定义为 Eckardt 评分降至≤3。当有条件时，报告 POEM 后食管酸暴露测试/ pH 阻抗和测压的结果。
共 10 例 RYGB 术后贲门失弛缓症患者接受了 POEM。7 例患者行前肌切开术，所有手术均技术成功。黏膜下隧道长度和肌切开长度的平均值分别为 12.9cm 和 11.1cm。平均手术时间为 72 分钟，平均住院时间为 1.5 天。10 例患者均获得临床成功，Eckardt 评分从 6.5 显著降至 1（<0.001）。所有患者均无术后反流。6 例患者进行了术后 pH 检测，均正常。
本研究表明 POEM 在 RYGB 术后患者中是可行、安全且有效的。这些患者在 POEM 后发生胃食管反流病的风险似乎很小。
