Ichkhanian Yervant, Sanaei Omid, Canakis Andrew, Vosoughi Kia, Almazan Erik, Ghandour Bachir, Khashab Mouen A
Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, United States.
Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts, United States.
Endosc Int Open. 2020 Sep;8(9):E1137-E1143. doi: 10.1055/a-1198-4643. Epub 2020 Aug 31.
Esophagogastric junction outflow obstruction (EGJOO) is a rare esophageal dysmotility disease that is characterized by elevated integrated relaxation pressuse (IRP) with evidence of preserved peristalsis. The role of peroral endoscopic myotomy (POEM) in management of EGJOO is currently unknown. This is a prospective trial conducted in a single US tertiary care center from June 2015 to June 2019. Symptomatic patients, diagnosed with EGJOO on both HRM and endoluminal functional lumen imaging probe (EndoFLIP), who were eligible for POEM were recruited. Primary outcome was clinical success, defined as Eckardt score (ES) ≤ 3, at 6 months post-POEM. Other outcomes included dysphagia score, quality of life as measured by 36-item Short Form health survey scales (SF-36), post-POEM HRM, EndoFLIP, and pH measurements, and adverse events. A total of 15 patients (51.8 yr. 9 F) with EGJOO underwent POEM. Pre-POEM mean IRP on HRM and Distensibility index (DI) on EndoFLIP were 24.3 ± 2.2 mmHg and 1.1 ± 0.6 mm /mmHg, respectively. Clinical success was achieved in 93 % at 6 months post-POEM. There was significant decrease in IRP (-17.6 mmHg) post-POEM. There was significant improvement at 6 months in two of the SF-36 subscales. Ten patients underwent post-POEM pH testing, seven of whom had abnormal DeMeester score. Seven patients underwent EGD evaluation revealing esophagitis in five (2 Los Angeles grade A and 3 grade B). POEM offers a high clinical success rate for patients with EGJOO confirmed by impedance planimetry.
食管胃交界部流出道梗阻（EGJOO）是一种罕见的食管动力障碍性疾病，其特征是综合松弛压（IRP）升高且蠕动保留。经口内镜下肌切开术（POEM）在EGJOO治疗中的作用目前尚不清楚。这是一项于2015年6月至2019年6月在美国一家三级医疗中心进行的前瞻性试验。招募了经高分辨率测压（HRM）和腔内功能性管腔成像探头（EndoFLIP）诊断为EGJOO且符合POEM条件的有症状患者。主要结局是POEM术后6个月的临床成功，定义为埃卡德特评分（ES）≤3。其他结局包括吞咽困难评分、用36项简明健康调查量表（SF-36）测量的生活质量、POEM术后的HRM、EndoFLIP和pH测量以及不良事件。共有15例（平均年龄51.8岁，9例女性）EGJOO患者接受了POEM。POEM术前HRM上的平均IRP和EndoFLIP上的扩张性指数（DI）分别为24.3±2.2 mmHg和1.1±0.6 mm/mmHg。POEM术后6个月临床成功率为93%。POEM术后IRP显著降低（-17.6 mmHg）。SF-36的两个子量表在6个月时有显著改善。10例患者接受了POEM术后pH检测，其中7例DeMeester评分异常。7例患者接受了内镜检查，其中5例发现食管炎（2例洛杉矶A级和3例B级）。对于经阻抗平面测量确诊的EGJOO患者，POEM具有较高的临床成功率。
