Vackova Zuzana, Mares Jan, Krajciova Jana, Rabekova Zuzana, Zdrhova Lucie, Loudova Pavla, Spicak Julius, Stirand Petr, Hucl Tomas, Martinek Jan
Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Institute of Physiology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
J Neurogastroenterol Motil. 2021 Apr 30;27(2):205-214. doi: 10.5056/jnm20126.
BACKGROUND/AIMS: Several studies have reported partial recovery of peristalsis in patients with achalasia after myotomy. The aim of our study is to analyze esophageal motility patterns after peroral endoscopic myotomy (POEM) and to assess the potential predictors and clinical impact of peristaltic recovery.
We performed a retrospective analysis of prospectively collected data of consecutive patients with achalasia undergoing POEM at a tertiary center. High-resolution manometry (HRM) studies prior to and after POEM were reviewed and the Chicago classification was applied.
A total of 237 patients were analyzed. The initial HRM diagnoses were achalasia type I, 42 (17.7%); type II, 173 (73.0%); and type III, 22 (9.3%). Before POEM, peristaltic fragments were present in 23 (9.7%) patients. After POEM the Chicago classification diagnoses were: 112 absent contractility, 42 type I achalasia, 15 type II, 11 type III, 26 ineffective esophageal motility, 18 esophagogastric junction outflow obstruction, 10 fragmented peristalsis, and 3 distal esophageal spasm. Altogether 68 patients (28.7%) had signs of contractile activity, but the contractions newly appeared in 47 patients (47/214, 22.0%). Type II achalasia showed a trend for appearance of contractions ( = 0.097). Logistic regression analysis did not identify any predictors of peristaltic recovery. The post-POEM Eckardt score did not differ between patients with and without contractions nor did the parameters of timed barium esophagogram.
More than 20% of achalasia patients have signs of partial recovery of esophageal peristalsis after POEM. It occurs predominantly in type II achalasia but the clinical relevance seems to be negligible.
背景/目的：多项研究报道贲门失弛缓症患者行肌切开术后蠕动有部分恢复。本研究旨在分析经口内镜下肌切开术（POEM）后的食管动力模式，并评估蠕动恢复的潜在预测因素及临床影响。
我们对一家三级中心连续接受POEM治疗的贲门失弛缓症患者的前瞻性收集数据进行回顾性分析。回顾了POEM术前和术后的高分辨率测压（HRM）研究，并应用芝加哥分类法。
共分析了237例患者。最初的HRM诊断为I型贲门失弛缓症42例（17.7%）；II型173例（73.0%）；III型22例（9.3%）。POEM术前，23例（9.7%）患者存在蠕动片段。POEM术后芝加哥分类诊断为：无收缩112例，I型贲门失弛缓症42例，II型15例，III型11例，无效食管动力26例，食管胃交界部流出道梗阻18例，蠕动片段10例，远端食管痉挛3例。共有68例患者（28.7%）有收缩活动迹象，但47例患者（47/214，22.0%）新出现了收缩。II型贲门失弛缓症有收缩出现的趋势（P = 0.097）。逻辑回归分析未发现蠕动恢复的任何预测因素。POEM术后Eckardt评分在有收缩和无收缩的患者之间没有差异，定时钡餐食管造影参数也无差异。
超过20%的贲门失弛缓症患者在POEM术后有食管蠕动部分恢复的迹象。这主要发生在II型贲门失弛缓症患者中，但临床相关性似乎可以忽略不计。
