Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
Dis Esophagus. 2021 Mar 8;34(3). doi: 10.1093/dote/doaa097.
Peroral endoscopic myotomy (POEM) has been increasingly accepted as the first-line treatment of achalasia. However, laparoscopic Heller myotomy or esophagectomy still remains as the mainstay treatment for advanced achalasia featured with megaesophagus and/or sigmoid-shaped esophagus. Although the efficacy of POEM for advanced achalasia with sigmoid-shaped esophagus has been described, little is known about the role of POEM for patients with megaesophagus. The aim of our study is to evaluate the efficacy and safety of POEM for advanced achalasia with megaesophagus. Patients who received initial examinations and underwent POEM in our hospital from June 2013 to December 2018 were identified and data were retrospectively analyzed. The advanced achalasia was defined as megaesophagus with a diameter of ≥6 cm. The primary outcome was clinical success. The secondary outcomes were technical success and adverse events. A total of 112 patients (50 females, 44.6%) were included with a mean age of 44.8 years. The median symptom duration was 6.5 years (IQR:3.0-13.0 years). Modified POEM techniques were used in 27.7% (31/112) of patients. Technical success rate was 99.1% (112/113) per procedure. Clinical success was seen in 93.1% patients with median Eckardt score decreasing from 8.0 to 1.0 (P < 0.001) during a median 31.0 months of follow-up. The mean LES pressure decreased from 29.5 mmHg to 14.2 mmHg after POEM (P < 0.05). Procedure-related adverse events occurred in 8.9% patients. Reflux disease was observed postoperatively in 26.7% of patients. POEM is also indicated for patients with advanced achalasia with a favorable safety and efficacy.
经口内镜肌切开术（POEM）已被越来越多地接受为贲门失弛缓症的一线治疗方法。然而，腹腔镜 Heller 肌切开术或食管切除术仍然是巨食管和/或乙状结肠型食管的晚期贲门失弛缓症的主要治疗方法。尽管已经描述了 POEM 治疗乙状结肠型晚期贲门失弛缓症的疗效，但对于巨食管患者，POEM 的作用知之甚少。我们的研究旨在评估 POEM 治疗巨食管晚期贲门失弛缓症的疗效和安全性。从 2013 年 6 月至 2018 年 12 月，我们医院对接受初始检查并接受 POEM 治疗的患者进行了识别，并对数据进行了回顾性分析。晚期贲门失弛缓症定义为直径≥6cm 的巨食管。主要结局是临床疗效。次要结局是技术成功率和不良事件。共纳入 112 例患者（女性 50 例，44.6%），平均年龄为 44.8 岁。中位症状持续时间为 6.5 年（IQR：3.0-13.0 年）。27.7%（31/112）的患者采用改良 POEM 技术。每例手术的技术成功率为 99.1%（112/113）。93.1%的患者临床疗效显著，Eckardt 评分中位数从 8.0 分降至 1.0 分（P<0.001），中位随访 31.0 个月。POEM 后食管下括约肌压力从 29.5mmHg 降至 14.2mmHg（P<0.05）。8.9%的患者发生与操作相关的不良事件。26.7%的患者术后出现反流性疾病。POEM 也适用于疗效和安全性良好的晚期贲门失弛缓症伴巨食管患者。
