标记引导下标准经口内镜肌切开术的疗效和安全性：一项回顾性病例对照研究。
Effect and safety of mark-guided standard peroral endoscopic myotomy: A retrospective case control study.
机构信息
Department of Gastroenterology, the Second Clinical Medicine College (Shenzhen People's Hospital) of Jinan University, Shenzhen 518020, Guangdong Province, China.
出版信息
World J Gastroenterol. 2020 Mar 7;26(9):973-983. doi: 10.3748/wjg.v26.i9.973.
BACKGROUND
Peroral endoscopic myotomy (POEM) is a promising therapeutic modality for esophageal achalasia worldwide. However, clinical failure and adverse events of POEM have still been concerned.
AIM
To compare the efficacy and safety of a novel mark-guided POEM with standard POEM.
METHODS
A total of 133 patients with esophageal achalasia who underwent POEM from May 2013 to May 2019 were enrolled in this retrospective study. Of the 133 patients, there were 64 patients in the mark-guided POEM group and 69 patients in the standard POEM group. The clinical success, procedural duration and adverse events were compared between the two groups at 3 mo, 12 mo and 24 mo postoperatively.
RESULTS
Characteristic baseline was similar in the mark-guided POEM group and standard POEM group. The clinical success was comparable between the two groups, ranging from 92% to 98%, at 3 mo, 12 mo and 24 mo postoperatively (all > 0.5). Eckart score, Gastroesophageal Reflux Disease Questionnaire score and SF-36 score were not different between the two groups after treatment (all > 0.05). No severe adverse events occurred in the two groups. However, mark-guided POEM required shorter procedural duration, and less use of proton pump inhibitors and lower incidence of reflux symptoms than the standard POEM (all < 0.001).
CONCLUSION
Mark-guided POEM and standard POEM were both effective and safe for the treatment of esophageal achalasia. However, the mark-guided POEM was characterized by shorter procedural duration, less use of proton pump inhibitors and lower incidence of reflux symptoms.
背景
经口内镜下肌切开术（POEM）是一种有前途的治疗食管贲门失弛缓症的方法，在全球范围内得到了广泛应用。然而，POEM 的临床失败和不良事件仍然受到关注。
目的
比较新型标记引导 POEM 与标准 POEM 的疗效和安全性。
方法
本回顾性研究纳入了 2013 年 5 月至 2019 年 5 月期间接受 POEM 治疗的 133 例食管贲门失弛缓症患者。其中 64 例患者接受标记引导 POEM（标记引导 POEM 组），69 例患者接受标准 POEM（标准 POEM 组）。比较两组患者术后 3 个月、12 个月和 24 个月时的临床疗效、手术时间和不良事件。
结果
标记引导 POEM 组和标准 POEM 组的特征性基线相似。两组患者术后 3 个月、12 个月和 24 个月的临床疗效相当，均为 92%~98%（均 > 0.5）。治疗后两组的 Eckart 评分、胃食管反流病问卷评分和 SF-36 评分无差异（均 > 0.05）。两组均未发生严重不良事件。然而，与标准 POEM 相比，标记引导 POEM 组的手术时间更短，质子泵抑制剂的使用更少，反流症状的发生率更低（均 < 0.001）。
结论
标记引导 POEM 和标准 POEM 治疗食管贲门失弛缓症均有效且安全。然而，标记引导 POEM 具有手术时间更短、质子泵抑制剂使用更少和反流症状发生率更低的特点。
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