贲门失弛缓症经口内镜下肌切开术中心肌固有层与临床结局的关系。
The relationship between cardiac muscularis propria and clinical outcomes of peroral endoscopic myotomy in achalasia.
机构信息
Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, PR China.
Department of Gastroenterology, The First People's Hospital of Qinzhou, Qinzhou, Guangxi Zhuang Autonomous Region 535000, PR China.
出版信息
Clin Res Hepatol Gastroenterol. 2021 Jul;45(4):101529. doi: 10.1016/j.clinre.2020.08.007. Epub 2020 Nov 29.
BACKGROUND AND AIM
Achalasia patients usually present lower esophageal sphincter thickening, which can impact the expansibility of cardia. We aimed to investigate the effect of cardiac muscularis propria (MP) on perioperative adverse events (AEs) and treatment outcomes of patients treated with peroral endoscopic myotomy (POEM).
METHODS
We retrospectively reviewed 114 patients with achalasia undergoing pre-POEM endoscopic ultrasonography (EUS) between May 2013 and November 2019. Cardiac MP thickness was measured using EUS. POEM failure was defined as Eckardt score >3. Risk factors for perioperative AEs and POEM failure were identified.
RESULTS
Patients were divided into the thin (n = 52) and the thick group (n = 62) based on the median of cardiac MP thickness (3.0 mm). Perioperative AEs rate of the thin group seemed to be slightly higher than that of the thick group (11.5% vs. 4.8%, P = 0.30). During a median follow-up of 30 months (range 1-77), 100 patients completed follow-up, 16 (16%) of which occurred clinical failure. The clinical outcomes of patients in the thin group were significantly poorer than those patients in the thick group (P = 0.006). Cardiac MP thickness was an independent risk factor for POEM failure (hazard ratio 3.9, P = 0.02; Cox regression), but not the risk factor for perioperative AEs (odds ratio 2.6, P = 0.2; logistic regression).
CONCLUSION
Cardiac MP thickness could be a novel predictive factor for POEM failure in patients with achalasia.
背景与目的
贲门失弛缓症患者通常表现为食管下括约肌增厚，这可能影响贲门的扩张性。我们旨在研究贲门固有肌（MP）厚度对经口内镜肌切开术（POEM）治疗患者围手术期不良事件（AE）和治疗结果的影响。
方法
我们回顾性分析了 2013 年 5 月至 2019 年 11 月间 114 例接受 POEM 术前内镜超声（EUS）检查的贲门失弛缓症患者。使用 EUS 测量贲门 MP 厚度。POEM 失败的定义为 Eckardt 评分>3。确定围手术期 AE 和 POEM 失败的危险因素。
结果
根据贲门 MP 厚度的中位数（3.0mm），将患者分为薄组（n=52）和厚组（n=62）。薄组的围手术期 AE 发生率似乎略高于厚组（11.5%比 4.8%，P=0.30）。在中位数为 30 个月（范围 1-77）的随访期间，100 例患者完成了随访，其中 16 例（16%）发生临床失败。薄组患者的临床结局明显差于厚组患者（P=0.006）。贲门 MP 厚度是 POEM 失败的独立危险因素（风险比 3.9，P=0.02；Cox 回归），但不是围手术期 AE 的危险因素（优势比 2.6，P=0.2；逻辑回归）。
结论
贲门 MP 厚度可能是贲门失弛缓症患者 POEM 失败的一个新的预测因素。
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