Division of Gastroenterology & Hepatology, Stanford University Hospital, GI Suite, 430 Broadway, Pavilion C-3rd Floor, Redwood City, CA, 94063, USA.
Division of General Surgery, Stanford University Hospital, Stanford, CA, USA.
Surg Endosc. 2021 Feb;35(2):792-801. doi: 10.1007/s00464-020-07450-6. Epub 2020 Mar 10.
Many centers have reported excellent short-term efficacy of per-oral endoscopic myotomy (POEM) for the treatment of achalasia. However, long-term data are limited and there are few studies comparing the efficacy of POEM versus Heller Myotomy (HM).
To compare the long-term clinical efficacy of POEM versus HM.
Using a retrospective, parallel cohort design, all cases of POEM or HM for achalasia between 2010 and 2015 were assessed. Clinical failure was defined as (a) Eckardt Score > 3 for at least 4 weeks, (b) achalasia-related hospitalization, or (c) repeat intervention. All index manometries were classified via Chicago Classification v3. Pre-procedural clinical, manometric, radiographic data, and procedural data were reviewed.
98 patients were identified (55 POEM, 43 Heller) with mean follow-up of 3.94 years, and 5.44 years, respectively. 83.7% of HM patients underwent associated anti-reflux wrap (Toupet or Dor). Baseline clinical, demographic, radiographic, and manometric data were similar between the groups. There was no statistical difference in overall long-term success (POEM 72.7%, HM 65.1% p = 0.417, although higher rates of success were seen in Type III Achalasia in POEM vs Heller (53.3% vs 44.4%, p < 0.05). Type III Achalasia was the only variable associated with failure on a univariate COX analysis and no covariants were identified on a multivariate Cox regression. There was no statistical difference in GERD symptoms, esophagitis, or major procedural complications.
POEM and HM have similar long-term (4-year) efficacy with similar adverse event and reflux rates. POEM was associated with greater efficacy in Type III Achalasia.
许多中心报告了经口内镜肌切开术（POEM）治疗贲门失弛缓症的短期疗效优异。然而，长期数据有限，且比较 POEM 与 Heller 肌切开术（HM）疗效的研究较少。
比较 POEM 与 HM 治疗贲门失弛缓症的长期临床疗效。
采用回顾性平行队列设计，评估 2010 年至 2015 年间所有接受 POEM 或 HM 治疗的贲门失弛缓症病例。临床失败定义为（a）Eckardt 评分>3 至少 4 周，（b）与贲门失弛缓症相关的住院治疗，或（c）再次干预。所有指数测压均通过芝加哥分类 v3 进行分类。回顾性分析术前临床、测压、影像学和手术数据。
共纳入 98 例患者（55 例 POEM，43 例 HM），平均随访 3.94 年和 5.44 年。HM 患者中 83.7%行抗反流包裹术（Toupet 或 Dor）。两组间基线临床、人口统计学、影像学和测压数据相似。总体长期成功率无统计学差异（POEM 72.7%，HM 65.1%，p=0.417，尽管 POEM 中 III 型贲门失弛缓症的成功率更高（53.3%比 44.4%，p<0.05）。单因素 COX 分析显示，III 型贲门失弛缓症是失败的唯一相关变量，多因素 COX 回归未发现协变量。GERD 症状、食管炎或主要手术并发症无统计学差异。
POEM 和 HM 的长期（4 年）疗效相似，不良反应和反流发生率相似。POEM 与 III 型贲门失弛缓症的疗效更相关。
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