II 型贲门失弛缓症经口内镜肌切开术治疗后效果相当理想。
Type II achalasia is associated with a comparably favorable outcome following per oral endoscopic myotomy.
机构信息
Division of Gastroenterology, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Dis Esophagus. 2021 Jun 14;34(6). doi: 10.1093/dote/doaa107.
Per oral endoscopic myotomy (POEM) is a safe and effective treatment for esophageal motility disorder in treatment-naïve patients as well as salvage therapy. Though type II achalasia, compared to other subtypes, is reported to have a more favorable outcome with pneumatic dilation (PD) or Heller myotomy (HM), it is unclear whether achalasia subtype predicts symptom response to POEM. We aimed to evaluate whether type II achalasia is associated with a comparably favorable outcome following POEM. We performed a retrospective review of patients with esophageal motility disorder who were referred for POEM from April 2014 to June 2017. The main outcome was clinical success based on Eckardt score ≤3 and its association with subtype and safety. A total of 63 patients (mean age 51 years [SD 15]; 63% male) underwent a total of 68 POEMs with median of 263 days follow-up. Of these, 45 (71.3%) patients were type II achalasia. In all, 29 (46%) patients were treatment-naïve and 34 (54%) patients had previous endoscopic or surgical therapy including botulinum toxin injection in 16 (25%), PD in 10 (16%), both botulinum toxin injection and PD in 8 (13%) and HM in 3 (5%). Technical success was 100% and clinical success was achieved in 51 (81%) patients. The rate of clinical success was higher in patients with type II achalasia compared to the other subtypes (88.9% vs. 61.1% [P = 0.028]) and type II achalasia patients required fewer redo POEM (2.2% vs. 22.2% [P = 0.021]). Multivariate logistic regression analysis demonstrated the positive prediction of clinical success for type II achalasia following POEM (P = 0.046). As observed with PD and HM, type II achalasia was associated with a favorable clinical outcome following POEM.
经口内镜下肌切开术（POEM）是一种安全有效的治疗方法，可用于治疗初治患者以及挽救性治疗食管动力障碍。尽管与其他亚型相比，Ⅱ型贲门失弛缓症在接受气囊扩张（PD）或 Heller 肌切开术（HM）治疗时效果更好，但贲门失弛缓症的亚型是否预测 POEM 的症状反应尚不清楚。我们旨在评估Ⅱ型贲门失弛缓症与 POEM 后相似的良好效果是否相关。我们对 2014 年 4 月至 2017 年 6 月因食管动力障碍而行 POEM 的患者进行了回顾性研究。主要结果是根据 Eckardt 评分≤3 评估的临床成功率及其与亚型和安全性的关系。共有 63 名患者（平均年龄 51 岁[标准差 15]；63%为男性）共行 68 次 POEM，中位随访时间为 263 天。其中 45 例（71.3%）为Ⅱ型贲门失弛缓症。所有患者中，29 例（46%）为初治患者，34 例（54%）患者既往接受过内镜或手术治疗，包括 16 例（25%）肉毒毒素注射、10 例（16%）PD、8 例（13%）肉毒毒素注射和 PD 联合治疗、3 例（5%）HM。技术成功率为 100%，51 例（81%）患者获得临床成功。与其他亚型相比，Ⅱ型贲门失弛缓症患者的临床成功率更高（88.9%比 61.1%，P=0.028），需要再次行 POEM 的患者更少（2.2%比 22.2%，P=0.021）。多变量逻辑回归分析表明，POEM 后Ⅱ型贲门失弛缓症与临床成功呈正相关（P=0.046）。与 PD 和 HM 一样，Ⅱ型贲门失弛缓症与 POEM 后良好的临床结果相关。
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