Department of Surgery, Eastern Health Clinical School, Monash University, Clayton, VIC, Australia.
Melbourne Upper GI Surgical Group, Melbourne, VIC, Australia.
Surg Endosc. 2021 May;35(5):1931-1948. doi: 10.1007/s00464-020-08282-0. Epub 2021 Feb 9.
Peroral endoscopic myotomy (POEM) is increasingly used as primary treatment for esophageal achalasia, in place of the options such as Heller myotomy (HM) and pneumatic dilatation (PD) OBJECTIVE: These evidence-based guidelines from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) intend to support clinicians, patients and others in decisions about the use of POEM for treatment of achalasia.
The panel agreed on 4 recommendations for adults and children with achalasia.
Strong recommendation for the use of POEM over PD was issued unless the concern of continued postoperative PPI use remains a key decision-making concern to the patient. Conditional recommendations included the option of using either POEM or HM with fundoplication to treat achalasia, and favored POEM over HM for achalasia subtype III.
经口内镜下肌切开术（POEM）越来越多地被用作治疗食管失弛缓症的主要方法，取代了 Heller 肌切开术（HM）和气囊扩张术（PD）等选择。
这些来自美国胃肠内镜外科医师学会（SAGES）的循证指南旨在为临床医生、患者和其他人员提供关于 POEM 治疗失弛缓症的使用决策支持。
专家组就成人和儿童失弛缓症的 4 项建议达成一致。
强烈建议使用 POEM 而不是 PD，除非患者继续使用术后质子泵抑制剂（PPI）的担忧仍然是一个关键的决策因素。有条件的建议包括使用 POEM 或 HM 联合胃底折叠术治疗失弛缓症的选择，并且 POEM 优于 HM 治疗失弛缓症 III 型。
