Demeter Michal, Ďuriček Martin, Vorčák Martin, Hyrdel Rudolf, Kunda Rastislav, Bánovčin Peter
Gastroenterology Clinic - Jessenius Faculty of Medicine, Comenius University in Bratislava (JFM CU), Martin, Slovakia.
Clinic of Radiology - Jessenius Faculty of Medicine, Comenius University in Bratislava (JFM CU), Martin, Slovakia.
Scand J Gastroenterol. 2020 Apr;55(4):509-514. doi: 10.1080/00365521.2020.1745881. Epub 2020 Apr 6.
Standard treatment for esophageal epiphrenic diverticula associated with achalasia includes surgical diverticulectomy, myotomy and anterior fundoplication. However, several case reports published recently suggest that endoscopic approach using per oral endoscopic myotomy is a safe and effective alternative. This is a retrospective review of a single center case series of patients with achalasia and epiphrenic diverticula. During the treatment, the POEM guided on the opposite site of the diverticular neck without diverticulotomy was performed. Symptomatic outcome was evaluated 3 months after procedure and afterwards with the median follow-up time of 24 months. High resolution manometry was performed 3 months after the procedure. Seven patients with esophageal epiphrenic diverticula were included. POEM was successfully performed in all patients, with no complications in the periprocedural period. We observed a significant reduction of Eckardt score and the relaxation pressure of the lower esophageal sphincter (31.8 vs. 8.8 mmHg, < .0001). POEM is a promising approach in the management of achalasia and esophageal epiphrenic diverticula. We demonstrated its safety, efficiency and ability to provide symptom reduction and decrease of the LES relaxation pressure even without diverticulotomy. Multicentric studies on larger cohorts of patients and with longer follow-up time are required to confirm these results.
与贲门失弛缓症相关的食管膈上憩室的标准治疗方法包括手术憩室切除术、肌切开术和前胃底折叠术。然而，最近发表的几篇病例报告表明，经口内镜下肌切开术的内镜治疗方法是一种安全有效的替代方案。这是一项对单一中心贲门失弛缓症和膈上憩室患者病例系列的回顾性研究。在治疗过程中，在不进行憩室切开术的情况下，在憩室颈部对侧进行经口内镜下肌切开术（POEM）。术后3个月评估症状改善情况，之后进行随访，中位随访时间为24个月。术后3个月进行高分辨率测压。纳入了7例食管膈上憩室患者。所有患者均成功完成POEM，围手术期无并发症。我们观察到埃卡德特评分和食管下括约肌松弛压显著降低（31.8 vs. 8.8 mmHg，P <.0001）。POEM是治疗贲门失弛缓症和食管膈上憩室的一种有前景的方法。我们证明了其安全性、有效性以及即使不进行憩室切开术也能减轻症状和降低食管下括约肌松弛压的能力。需要对更多患者群体进行多中心研究并延长随访时间来证实这些结果。
