Albers David, Frieling Thomas, Dakkak Dani, Kuhlbusch-Zicklam Rita, Töx Ulrich, Gittinger Mathis, Schumacher Brigitte
Department of Internal Medicine and Gastroenterology, Elisabeth-Krankenhaus Essen, Essen, Germany.
Department of Internal Medicine and Gastroenterology, Helios Klinikum Krefeld, Krefeld, Germany.
Z Gastroenterol. 2018 Nov;56(11):1337-1342. doi: 10.1055/a-0668-2605. Epub 2018 Oct 8.
BACKGROUND: Noncardiac chest pain (NCCP) is recurrent angina pectoris-like pain without evidence of coronary heart disease in conventional diagnostic evaluation. In gastroenterology, managing of patients with NCCP is ambiguous to detect gastroesophageal reflux and hypercontractile esophageal motility disorders. Recently, peroral endoscopic myotomy (POEM) was established as treatment option in achalasia. However, limited data exist on the effectivity of POEM in NCCP with hypercontractile esophageal motility disorders. MATERIAL AND METHODS: In this prospective study (POEM-HYPE), we evaluated 14 patients with NCCP and hypercontractile esophageal motility disorders (type III achalasia, n = 7; hypercontractile esophagus, n = 6; distal esophageal spasm, n = 1). All patients underwent standardized diagnostic work-up including esophagogastroduodenoscopy with esophageal biopsies, high-resolution esophageal manometry, and combined intraluminal impedance and pH testing before and 3 weeks after POEM. A standardized symptom questionnaire was disposed before POEM, 3 weeks after, and every 6 months after the POEM. RESULTS: After POEM, 12 patients showed significant symptom relief (pre-Eckardt score: 7.78 ± 1.47, 3 weeks post: 1.64 ± 1.44, 6 months: 2.0 ± 1.84 and 1.86 ± 1.89 after 15.0 ± 10.0 months post-intervention). High-resolution manometry showed significant reduction in integrated relaxation pressure (pre-POEM: 24.74 ± 18.9 mm Hg, post-POEM: 13.8 ± 16.5 mm Hg) and distal contractile integral (pre-POEM: 2880 ± 3700 mmHgscm, post-POEM: 1109 ± 1042 mmHgscm). One lesion of the submucosal tunnel occurred as a moderate adverse event and was handled endoscopically. The long-term clinical success rate was 85.7 %. No severe gastroesophageal reflux occurred after interventions. Two patients required secondary therapy with injection of botulinum toxin in the tubular esophagus and balloon dilation. CONCLUSION: The results suggest that POEM is an effective and safe therapeutic option for patients with NCCP and hypercontractile esophageal motility disorders.
背景：非心源性胸痛（NCCP）是指在传统诊断评估中出现类似心绞痛的反复性胸痛，但无冠心病证据。在胃肠病学领域，对NCCP患者进行管理以检测胃食管反流和食管动力亢进性疾病存在一定的模糊性。最近，经口内镜下肌切开术（POEM）已成为贲门失弛缓症的一种治疗选择。然而，关于POEM治疗NCCP合并食管动力亢进性疾病的有效性的数据有限。 材料与方法：在这项前瞻性研究（POEM-HYPE）中，我们评估了14例NCCP合并食管动力亢进性疾病的患者（III型贲门失弛缓症7例；食管动力亢进6例；食管远端痉挛1例）。所有患者在POEM术前、术后3周均接受了标准化的诊断检查，包括食管胃十二指肠镜检查及食管活检、高分辨率食管测压以及腔内阻抗与pH联合检测。在POEM术前、术后3周以及术后每6个月发放标准化症状问卷。 结果：POEM术后，12例患者症状明显缓解（术前埃卡德特评分：7.78±1.47，术后3周：1.64±1.44，术后6个月：2.0±1.84，干预后15.0±10.0个月为1.86±1.89）。高分辨率测压显示综合松弛压显著降低（POEM术前：24.74±18.9mmHg，POEM术后：13.8±16.5mmHg）以及远端收缩积分显著降低（POEM术前：2880±3700mmHgscm，POEM术后：1109±1042mmHgscm）。发生1例黏膜下隧道病变，为中度不良事件，经内镜处理。长期临床成功率为85.7%。干预后未发生严重胃食管反流。2例患者需要在食管管段注射肉毒杆菌毒素及球囊扩张进行二次治疗。 结论：结果表明，POEM是治疗NCCP合并食管动力亢进性疾病患者的一种有效且安全的治疗选择。
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