Asian Institute of Gastroenterology, Hyderabad, India.
J Clin Gastroenterol. 2021 Aug 1;55(7):594-601. doi: 10.1097/MCG.0000000000001395.
Spastic esophageal motility disorders (SEMD) are a rare group of motility disorders including type III achalasia, distal esophageal spasm (DES), and Jackhammer esophagus (JHE). Limited data suggest that per-oral endoscopic myotomy (POEM) may be effective in these disorders. In this study, we aimed to evaluate the long-term outcomes of POEM in SEMD.
The data of patients with SEMD who underwent POEM (January 2013 to December 2019) were analyzed, retrospectively. The following outcomes were recorded: POEM procedure details, technical and clinical success, adverse events, and gastroesophageal reflux disease (GERD). Clinical success was classified as immediate (<1 y), short-term (1 to 3 y), medium term (3 to 5 y), and long-term (>5 y).
A total of 1115 POEM procedures were performed during the study period for achalasia and nonachalasia spastic motility disorders. POEM was performed for SEMD in 74 (6.6%) patients including type III in 53, DES in 11, and JHE in 10 patients. Technical success was achieved in all the patients. The median follow-up for the entire group was 47.5 months (range: 2 to 77 mo). Clinical success at short-term (1 to 3 y) and long-term follow-up (>5 y) was attained in 85.2% and 82.6% patients, respectively. There was no significant difference in the clinical success between type III achalasia and JHE/DES. Mild and moderate adverse events were recorded in 21 (28.4%) cases. GERD was detected in 23 (56.1%) patients with 24-hour pH study. Erosive esophagitis and symptomatic GERD were found in 36 (48.6%) and 16 (21.6%) patients, respectively.
POEM is a safe, effective, and durable treatment modality for spastic motility disorders of the esophagus. However, GERD is found in about half of the patients mandating close monitoring after POEM.
痉挛性食管运动障碍（SEMD）是一组罕见的运动障碍，包括 III 型贲门失弛缓症、远端食管痉挛（DES）和贲门失弛缓症（JHE）。有限的数据表明，经口内镜肌切开术（POEM）可能对这些疾病有效。在这项研究中，我们旨在评估 POEM 在 SEMD 中的长期疗效。
回顾性分析了 2013 年 1 月至 2019 年 12 月期间接受 POEM 治疗的 SEMD 患者的数据。记录了以下结果：POEM 手术细节、技术和临床成功率、不良事件和胃食管反流病（GERD）。临床成功率分为即刻（<1 年）、短期（1-3 年）、中期（3-5 年）和长期（>5 年）。
研究期间共行 1115 例 POEM 治疗贲门失弛缓和非贲门失弛缓性痉挛性运动障碍。74 例（6.6%）患者因 SEMD 行 POEM 治疗，其中 53 例为 III 型，11 例为 DES，10 例为 JHE。所有患者均达到技术成功。全组中位随访时间为 47.5 个月（范围：2-77 个月）。短期（1-3 年）和长期（>5 年）随访时的临床成功率分别为 85.2%和 82.6%。III 型贲门失弛缓和 JHE/DES 的临床成功率无显著差异。21 例（28.4%）患者出现轻度和中度不良事件。23 例（56.1%）患者行 24 小时 pH 研究发现 GERD。36 例（48.6%）和 16 例（21.6%）患者分别发现糜烂性食管炎和有症状的 GERD。
POEM 是治疗食管痉挛性运动障碍的一种安全、有效、持久的治疗方法。然而，约一半的患者在 POEM 后会出现 GERD，需要密切监测。
