Departments of Gastroenterology and Hepatology.
Quantitative Health Sciences.
J Clin Gastroenterol. 2020 Apr;54(4):338-343. doi: 10.1097/MCG.0000000000001235.
Outcomes of laparoscopic Heller myotomy in obese patients with achalasia are suboptimal along with the increased risk of gastroesophageal reflux disease (GERD). The impact of obesity on treatment success and GERD after peroral endoscopic myotomy (POEM) are not well known. Hence, our study aims were to compare the clinical outcomes and rates of GERD after POEM in nonobese versus obese patients with achalasia.
Chart review of all achalasia patients who underwent POEM at our institution between April 2014 and June 2018. Patients with timed barium esophagram (TBE) and high-resolution esophageal manometry (HREM) before POEM along with post-POEM TBE, HREM, and esophageal pH study were included. Patients were categorized into 2 groups, nonobese (body mass index <30 kg/m) and obese (body mass index ≥30 kg/m). Patient demographics, TBE, HREM, pH study findings, and Eckardt scores were compared between the 2 groups.
A total of 89 patients (46 nonobese; 43 obese) met the study criteria. There were no significant differences in age, gender, achalasia subtype, operative time, length of stay and complication rates between the 2 groups. Treatment success (Eckardt score ≤3) was similar in both groups (97.7% nonobese vs. 92.7% obese, P=0.35). Abnormal DeMeester scores on pH study (>14.72) were similar in nonobese and obese patients (58.7% vs. 46.5%, P=0.25). Symptomatic GERD was also similar in both groups (17.8% in nonobese vs. 20% in obese, P=0.79).
POEM is an equally safe and effective treatment option for both nonobese and obese patients with achalasia in the short-term. Interestingly, POEM does not lead to higher rates of GERD in obese compared with nonobese patients.
肥胖症患者的贲门失弛缓症经腹腔镜 Heller 肌切开术治疗效果不理想，且患胃食管反流病（GERD）的风险增加。肥胖症对经口内镜下肌切开术（POEM）治疗成功和 GERD 的影响尚不清楚。因此，我们的研究目的是比较非肥胖症与肥胖症贲门失弛缓症患者 POEM 后的临床疗效和 GERD 发生率。
对 2014 年 4 月至 2018 年 6 月期间在我院行 POEM 的所有贲门失弛缓症患者进行病历回顾。将所有在 POEM 前进行 timed barium esophagram（TBE）和 high-resolution esophageal manometry（HREM）检查，并在 POEM 后进行 TBE、HREM 和食管 pH 研究的患者纳入研究。将患者分为两组，非肥胖组（体重指数＜30kg/m）和肥胖组（体重指数≥30kg/m）。比较两组患者的人口统计学资料、TBE、HREM、pH 研究结果和 Eckardt 评分。
共有 89 例患者（46 例非肥胖组；43 例肥胖组）符合研究标准。两组患者的年龄、性别、贲门失弛缓症亚型、手术时间、住院时间和并发症发生率无显著差异。两组的治疗成功率（Eckardt 评分≤3）相似（97.7%非肥胖组 vs. 92.7%肥胖组，P=0.35）。pH 研究中异常 DeMeester 评分（＞14.72）在非肥胖组和肥胖组患者中相似（58.7% vs. 46.5%，P=0.25）。两组患者的症状性 GERD 也相似（非肥胖组 17.8% vs. 肥胖组 20%，P=0.79）。
POEM 是一种安全有效的治疗方法，在短期内可用于非肥胖和肥胖的贲门失弛缓症患者。有趣的是，POEM 不会导致肥胖患者的 GERD 发生率高于非肥胖患者。
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