经口内镜下肌切开术（POEM）治疗贲门失弛缓症的可行性：使用新型小口径内镜（thin-POEM）。

Feasibility of the peroral endoscopic myotomy (POEM) procedure with a new small-caliber endoscope (thin-POEM) in patients with achalasia.

机构信息

Department of Endoscopy, Specialties Hospital, National Medical Center Century XXI, Mexico City, Mexico.

Division of Gastroenterology and Hepatology, National Medical Center Century XXI, Mexico City, Mexico.

出版信息

Endoscopy. 2019 Apr;51(4):350-354. doi: 10.1055/a-0802-8826. Epub 2019 Jan 10.

DOI:10.1055/a-0802-8826

PMID:30630196

Abstract

BACKGROUND

Peroral endoscopic myotomy (POEM) is a recognized technique for patients with achalasia. We aimed to evaluate the feasibility of using a small-caliber endoscope (thin-POEM) to perform POEM in patients with achalasia.

METHODS

Naïve or previously treated patients were included between February 2016 and April 2018. A small-caliber (5.9 mm) nasoendoscope was used, with a modified closure method using cyanoacrylate. Strict follow-up was performed.

RESULTS

45 patients were included, aged 45.5 years (interquartile range [IQR] 22 - 69); 53 % (24/45) had type II achalasia. Median total time for thin-POEM was 54 minutes (IQR 37 - 77) and median myotomy length was 13.5 cm (IQR 6 - 20). Results pre-procedure and 3 months post were Eckardt score 10 vs. 1 ( < 0.001), integrated relaxation pressure (IRP) 25.3 vs. 8.5 mmHg ( < 0.001), and timed barium esophagram (TBE) 100 % severely delayed vs. 86 % normal ( < 0.001), respectively. Type III patients had the longest thin-POEM times (median 58 minutes [IQR 52 - 77]). Reflux was confirmed at 3 months clinically in 17 % of patients, endoscopically in 20 %, and on pH monitoring in 53 %. At 6 months and 12 months, 40 % and 33 % of patients remained positive on pH monitoring and were medically managed.

CONCLUSIONS

Thin-POEM seems to be a safe, effective, and efficient procedure for POEM in patients with achalasia, with good short-term follow-up results.

摘要

背景

经口内镜下肌切开术（POEM）是治疗贲门失弛缓症的公认技术。我们旨在评估使用小口径内镜（细 POEM）为贲门失弛缓症患者实施 POEM 的可行性。

方法

纳入 2016 年 2 月至 2018 年 4 月期间的初治或既往治疗过的患者。使用小口径（5.9mm）鼻内镜，采用氰基丙烯酸酯改良的闭合方法。严格进行随访。

结果

共纳入 45 例患者，年龄 45.5 岁（四分位间距 [IQR] 22-69）；53%（24/45）为 II 型贲门失弛缓症。细 POEM 的总时间中位数为 54 分钟（IQR 37-77），肌切开长度中位数为 13.5cm（IQR 6-20）。术前和术后 3 个月的 Eckardt 评分分别为 10 分和 1 分（ <0.001），整合松弛压（IRP）分别为 25.3mmHg 和 8.5mmHg（ <0.001），时间分辨钡餐食管造影（TBE）分别为 100%严重延迟和 86%正常（ <0.001）。III 型患者的细 POEM 时间最长（中位数 58 分钟 [IQR 52-77]）。术后 3 个月，17%的患者临床诊断为反流，20%的患者内镜下诊断为反流，53%的患者 pH 监测阳性。在 6 个月和 12 个月时，40%和 33%的患者 pH 监测仍为阳性，并接受药物治疗。