Kolb Jennifer M, Jonas Daniel, Funari Mateus Pereira, Hammad Hazem, Menard-Katcher Paul, Wagh Mihir S
Division of Gastroenterology, University of Colorado-Denver, Aurora, CO 80045, United States.
Department of Internal Medicine, University of Colorado Hospital, Aurora, CO 80045, United States.
World J Gastrointest Endosc. 2020 Dec 16;12(12):532-541. doi: 10.4253/wjge.v12.i12.532.
Per-oral endoscopic myotomy (POEM) is safe and effective for the treatment of achalasia. There is limited data on performance of POEM in patients with altered upper gastrointestinal anatomy, especially after bariatric surgery. Outcomes in patients with prior sleeve gastrectomy have not been reported.
To assess the efficacy and safety of POEM in patients with prior bariatric surgery.
A prospective POEM database was reviewed from 3/2017-5/2020 to identify patients who underwent POEM after prior bariatric surgery. Efficacy was assessed by technical success (defined as the ability to successfully complete the procedure) and clinical success [decrease in Eckardt score (ES) to ≤ 3 post procedure]. Safety was evaluated by recording adverse events.
Six patients (50% male, mean age 48 years) with a history of prior bariatric surgery who underwent POEM were included. Three had prior sleeve gastrectomy (SG) and three prior Roux-en-Y gastric bypass (RYGB). Four patients had achalasia subtype II and 2 had type I. Most (4) patients had undergone previous achalasia therapy. Technical success was 100%. Clinical success was achieved in 4 (67%) patients at mean follow-up of 21 mo. In one of the clinical failures, EndoFLIP evaluation demonstrated adequate treatment and candida esophagitis was noted as the likely cause of dysphagia. There were no major adverse events.
POEM is technically feasible after both RYGB and SG and offers an effective treatment for this rare group of patients where surgical options for achalasia are limited.
经口内镜下肌切开术（POEM）治疗贲门失弛缓症安全有效。关于POEM在有上消化道解剖结构改变的患者中的应用数据有限，尤其是在减肥手术后。既往接受袖状胃切除术患者的治疗结果尚未见报道。
评估POEM在既往接受减肥手术患者中的疗效和安全性。
回顾2017年3月至2020年5月的前瞻性POEM数据库，以确定在既往减肥手术后接受POEM的患者。通过技术成功率（定义为成功完成手术的能力）和临床成功率[术后埃卡德特评分（ES）降至≤3]评估疗效。通过记录不良事件评估安全性。
纳入6例既往有减肥手术史且接受POEM的患者（50%为男性，平均年龄48岁）。3例曾接受袖状胃切除术（SG），3例曾接受 Roux-en-Y胃旁路术（RYGB）。4例患者为贲门失弛缓症II型，2例为I型。大多数（4例）患者曾接受过贲门失弛缓症治疗。技术成功率为100%。平均随访21个月时，4例（67%）患者取得临床成功。在1例临床失败病例中，EndoFLIP评估显示治疗充分，念珠菌性食管炎被认为是吞咽困难的可能原因。无重大不良事件。
RYGB和SG术后行POEM在技术上可行，为贲门失弛缓症手术选择有限的这一罕见患者群体提供了一种有效的治疗方法。
