Liu Dan, Liu Yue-Yuan, Chen Jia-Xin, Song Lei, Zhou Yang-Yang, Ullah Saif, Zhao Li-Xia, Hai Bin, Zheng Qing-Fen, Li Dong-Ying, He De-Zhi, Liu Bing-Rong
Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.
Department of Gastroenterology, The Hospital of Hei Long Jiang Province, Harbin, Heilongjiang 150036, P.R. China.
Exp Ther Med. 2021 Mar;21(3):196. doi: 10.3892/etm.2021.9629. Epub 2021 Jan 8.
Peroral endoscopic myotomy (POEM) is the first-line treatment of achalasia cardia (AC). However, the efficacy of POEM in treating patients with advanced AC remains to be determined. The aim of the present study was to evaluate the feasibility and clinical outcome of POEM in treating patients with advanced AC involving different esophageal morphologies. The study was a single-center, retrospective analysis of patients suffering from advanced AC. The primary endpoint was the Eckardt score at the follow-up examination. Secondary endpoints were procedural-related details, including the operation time and length of myotomy, adverse events (AEs) and hospital stay, as well as post-procedural gastroesophageal reflux disease. The technical success rate was 100%. All 50 patients enrolled underwent successful endoscopic myotomy (conventional POEM, n=20; modified POEM, n=30). AEs were observed in 10 patients. During a 6- to 50-month follow-up period, 41 patients achieved clinical success as evidenced by a decrease in the Eckardt score. Only 3 of 6 patients with a sigmoid-shaped megaesophagus obtained symptomatic relief. Symptomatic reflux occurred in 13 of 46 patients who completed their follow-up. In conclusion, POEM is safe, feasible and effective in treating advanced AC. Patients with a sigmoid-shaped megaesophagus are less likely to report palliation of symptoms.
经口内镜下肌切开术（POEM）是贲门失弛缓症（AC）的一线治疗方法。然而，POEM治疗晚期AC患者的疗效仍有待确定。本研究的目的是评估POEM治疗涉及不同食管形态的晚期AC患者的可行性和临床结果。该研究是对晚期AC患者进行的单中心回顾性分析。主要终点是随访检查时的埃卡德特评分。次要终点是与手术相关的细节，包括手术时间和肌切开长度、不良事件（AE）和住院时间，以及术后胃食管反流病。技术成功率为100%。所有纳入的50例患者均成功接受了内镜下肌切开术（传统POEM，n = 20；改良POEM，n = 30）。10例患者观察到不良事件。在6至50个月的随访期内，41例患者获得临床成功，埃卡德特评分降低证明了这一点。6例乙状结肠型巨食管患者中只有3例症状缓解。46例完成随访的患者中有13例出现症状性反流。总之，POEM治疗晚期AC安全、可行且有效。乙状结肠型巨食管患者症状缓解的可能性较小。
