Sanaka Madhusudhan R, Garg Rajat, Chadalavada Pravallika, Thota Prashanthi N, Gabbard Scott, Parikh Malav P, Khoudari George, Murthy Sudish, Raja Siva
Departments of Gastroenterology and Hepatology.
Internal Medicine.
J Clin Gastroenterol. 2021 Jul 1;55(6):505-511. doi: 10.1097/MCG.0000000000001388.
In advanced achalasia patients with sigmoid esophagus, peroral endoscopic myotomy (POEM) might be technically challenging and its outcomes are not well known in western population. Hence, our study aims were to assess and compare the safety and efficacy of POEM in achalasia patients with and without sigmoid esophagus.
Medical records of achalasia patients who had POEM at our institution between April 2014 and December 2019 were reviewed. Patients who underwent work-up comprising timed barium esophagram (TBE) and high-resolution esophageal manometry (HREM) before POEM along with 2-month post-POEM esophageal pH study, TBE and HREM were included in the final analysis. Patients were categorized as either sigmoid or no sigmoid esophagus based on the morphology of esophagus on TBE as per Japan Esophageal Society guidelines. Treatment success was defined as reduction of post-POEM Eckardt score to ≤3.
A total of 168 patients (sigmoid esophagus=20; no sigmoid esophagus=148) were included. Esophageal width on TBE at 1 minute was significantly higher in sigmoid esophagus group compared with no sigmoid esophagus group (4.9 vs. 3.0 cm, P<0.001). Procedural outcomes and complications were similar in both groups. At 2-month follow-up, both groups had significant improvement in Eckardt scores, TBE, and HREM parameters. Treatment success was high and similar in both sigmoid and no sigmoid groups (94.4% vs. 93.2%, P=0.84). The rates of gastroesophageal reflux disease were also similar in both groups.
Our study findings suggest that POEM is safe and highly effective treatment for achalasia patients with sigmoid esophagus similar to those without sigmoid esophagus in western population. POEM should be considered as the treatment of choice in advanced achalasia with sigmoid esophagus.
在患有乙状结肠型食管的晚期贲门失弛缓症患者中，经口内镜下肌切开术（POEM）在技术上可能具有挑战性，且其在西方人群中的疗效尚不清楚。因此，我们的研究目的是评估和比较POEM在有和没有乙状结肠型食管的贲门失弛缓症患者中的安全性和疗效。
回顾了2014年4月至2019年12月期间在我们机构接受POEM治疗的贲门失弛缓症患者的病历。在POEM前接受包括定时钡餐食管造影（TBE）和高分辨率食管测压（HREM）以及POEM后2个月的食管pH研究、TBE和HREM检查的患者纳入最终分析。根据日本食管学会指南，根据TBE上食管的形态将患者分为乙状结肠型食管或非乙状结肠型食管。治疗成功定义为POEM后埃卡德特评分降至≤3。
共纳入168例患者（乙状结肠型食管=20例；非乙状结肠型食管=148例）。乙状结肠型食管组在TBE 1分钟时的食管宽度明显高于非乙状结肠型食管组（4.9对3.0 cm，P<0.001）。两组的手术结果和并发症相似。在2个月的随访中，两组的埃卡德特评分、TBE和HREM参数均有显著改善。乙状结肠型食管组和非乙状结肠型食管组的治疗成功率都很高且相似（94.4%对93.2%，P=0.84）。两组的胃食管反流病发生率也相似。
我们的研究结果表明，对于西方人群中患有乙状结肠型食管的贲门失弛缓症患者，POEM是一种安全且高效的治疗方法，类似于那些没有乙状结肠型食管的患者。POEM应被视为晚期乙状结肠型食管贲门失弛缓症的首选治疗方法。
