经口内镜肌切开术治疗食管失弛缓症经球囊扩张失败后的疗效。
Peroral endoscopic myotomy for the treatment of achalasia after failed pneumatic dilation.
机构信息
Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, 300070, China.
出版信息
Surg Endosc. 2021 Dec;35(12):6960-6968. doi: 10.1007/s00464-020-08207-x. Epub 2021 Jan 4.
BACKGROUND AND AIMS
POEM is a rescue endoscopic therapy for patients who had previously failed surgical or endoscopic treatment. However, data regarding its effectiveness after failed pneumatic dilation (PD) and its long-term effects are limited. We aimed to retrospectively investigate the long-term outcomes in patients who had undergone POEM after failed PD.
METHODS
Data from 66 achalasia patients with a 2-year follow-up period were analyzed. Intraprocedural events were compared between the first POEM group (patients without prior-endoscopic intervention) and prior PD group (patients who had pre-POEM PD). Symptom evaluation, HRM and 24 h-pH DeMeester scores between the two groups were performed at 2 years after the POEM procedure. Muscularis externa samples were obtained from the lower esophagus using POEM to assess the muscle fibrosis with Azan-Mallory staining.
RESULTS
POEM was successfully performed for all achalasia patients. During the 2-year follow-up period, the success rate of POEM was 96.15% (25/26) for patients with prior PD and 95% (38/40) with primary POEM. For patients with type II achalasia and who underwent prior PD, the post-procedure DeMeester score was higher compared to patients who underwent POEM only (P < 0.05). A larger number of patients who underwent primary POEM (27.50%, 11/40) complained of mild heartburn compared to patients who underwent POEM after PD (7.69%, 2/26) (P < 0.05). With regards to fibrosis, the majority of patients who underwent POEM only were classified as F-1 (45.00%, 18/40), while the majority of patients who underwent prior PD were classified as F-2 (42.3%, 11/26). The degree of fibrosis was significantly different between the two groups (P < 0.05). Both surgical time and prior PD were correlated with the degree of fibrosis (P < 0.05).
CONCLUSIONS
Despite the technical challenges, pre-POEM endoscopic treatment does not impact the safety and efficacy of POEM in achalasia patients. Longer follow-up studies using larger cohorts are needed to determine long-term outcomes and complications of POEM.
背景与目的
POEM 是一种挽救性内镜治疗方法，适用于先前手术或内镜治疗失败的患者。然而，关于 POEM 治疗失败后气囊扩张（PD）的有效性及其长期效果的数据有限。本研究旨在回顾性分析 POEM 治疗失败后 PD 患者的长期结果。
方法
对 66 例接受 POEM 治疗并随访 2 年的贲门失弛缓症患者的数据进行分析。比较了首次 POEM 组（无先前内镜干预的患者）和先前 PD 组（行 POEM 前接受 PD 的患者）的术中事件。在 POEM 术后 2 年时，对两组患者进行症状评估、高分辨率测压（HRM）和 24 h-pH DeMeester 评分。使用 POEM 从食管下段获取外膜组织样本，通过阿赞-马洛里染色评估肌肉纤维化。
结果
所有贲门失弛缓症患者均成功完成 POEM。在 2 年的随访期间，先前 PD 组患者的 POEM 成功率为 96.15%（25/26），而初次 POEM 组为 95%（38/40）。对于 II 型贲门失弛缓症患者，行 PD 后患者的术后 DeMeester 评分高于仅行 POEM 的患者（P<0.05）。初次 POEM 组（27.50%，11/40）较 PD 后 POEM 组（7.69%，2/26）更多的患者诉轻度烧心（P<0.05）。关于纤维化程度，仅行 POEM 的患者多数被分类为 F-1（45.00%，18/40），而 PD 后行 POEM 的患者多数被分类为 F-2（42.3%，11/26）。两组间纤维化程度差异有统计学意义（P<0.05）。手术时间和 PD 均与纤维化程度相关（P<0.05）。
结论
尽管存在技术挑战，但 POEM 治疗失败前的内镜治疗并不影响贲门失弛缓症患者 POEM 的安全性和疗效。需要更大的队列进行长期随访研究，以确定 POEM 的长期结果和并发症。
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