Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, CSC H4/728, Madison, WI, 53792, USA.
Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
Surg Endosc. 2020 Apr;34(4):1704-1711. doi: 10.1007/s00464-019-06948-y. Epub 2019 Jul 10.
Heller myotomy (HM) has historically been considered the gold standard treatment for achalasia. Peroral endoscopic myotomy (POEM) is a less-invasive procedure and offers a quicker recovery. Although some studies have compared short-term outcomes of HM and POEM, predictors of long-term dysphagia resolution remain unclear. The objective of this study was to evaluate patient-reported outcomes for achalasia patients who underwent either POEM or HM over a 9-year period.
Data from our single academic institutional foregut database were used to identify achalasia patients who underwent HM or POEM from 2009 to 2018. Electronic health record data were reviewed to obtain patient characteristics and operative data. Achalasia severity stages were established for each patient using esophagram findings from an attending radiologist blinded to the procedure type. Postoperative outcomes were assessed via telephone for patients with at least 9 months of follow-up using Eckardt dysphagia scores. Patient age, sex, type of operation, and duration of follow-up were included in a multivariable linear regression model with Eckardt score as the outcome.
Our cohort included 141 patients (97 HM and 44 POEM). Eighty-two patients completed a phone survey at the 9 months or greater time interval (response rate = 58%). Mean Eckardt scores were 2.98 and 2.53 at a median follow-up of 3 years and 1 year for HM and POEM patients, respectively (an Eckardt score ≤ 3 is considered a successful myotomy). Lower stages of achalasia on esophagram (e.g., Stage 0 vs. Stage 4) were associated with greater dysphagia improvement. On multivariable analysis, operative approach was not associated with a statistically significant difference in dysphagia outcomes.
POEM and HM were associated with similar rates of dysphagia resolution for achalasia patients at a median of 2 years of follow-up. Both procedures appear to be durable options for achalasia treatment.
Heller 肌切开术（HM）一直被认为是贲门失弛缓症的金标准治疗方法。经口内镜肌切开术（POEM）是一种侵入性较小的手术，恢复更快。虽然一些研究比较了 HM 和 POEM 的短期结果，但长期吞咽困难缓解的预测因素仍不清楚。本研究的目的是评估接受 POEM 或 HM 治疗的贲门失弛缓症患者 9 年的患者报告结局。
我们的单机构消化道数据库中的数据用于识别 2009 年至 2018 年期间接受 HM 或 POEM 治疗的贲门失弛缓症患者。电子病历数据用于获取患者特征和手术数据。每位患者的贲门失弛缓症严重程度阶段由一位参加放射科医生根据食管造影结果确定，该放射科医生对手术类型不知情。对于至少随访 9 个月的患者，通过电话使用 Eckardt 吞咽困难评分评估术后结局。患者年龄、性别、手术类型和随访时间被纳入多变量线性回归模型，Eckardt 评分作为结果。
我们的队列包括 141 名患者（97 名 HM 和 44 名 POEM）。82 名患者在 9 个月或更长时间间隔完成了电话调查（应答率=58%）。HM 和 POEM 患者的中位随访时间分别为 3 年和 1 年时，平均 Eckardt 评分分别为 2.98 和 2.53（Eckardt 评分≤3 被认为是成功的肌切开术）。食管造影上较低的贲门失弛缓症阶段（例如，0 期与 4 期）与更大的吞咽困难改善相关。多变量分析显示，手术方法与吞咽困难结局无统计学显著差异。
POEM 和 HM 在中位随访 2 年后与贲门失弛缓症患者的吞咽困难缓解率相似。两种手术似乎都是贲门失弛缓症治疗的持久选择。
