Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center, T19-053, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA.
Surg Endosc. 2022 Feb;36(2):1619-1626. doi: 10.1007/s00464-021-08357-6. Epub 2021 Mar 17.
Achalasia is a debilitating primary esophageal motility disorder. Heller myotomy (HM) is a first-line therapy for the treatment of achalasia patients who have failed other modalities. Other indications for HM include diverticulum, diffuse esophageal spasm, and esophageal strictures. However, long-term outcomes of HM are unclear. This study aims to assess incidence of reintervention, either endoscopically or through minimally invasive or resectional procedures, in patients who underwent HM in New York State.
The Statewide Planning and Research Cooperative System (SPARCS) administrative longitudinal database identified 1817 adult patients who underwent HM between 2000 and 2008 for achalasia, esophageal diverticulum, diffuse esophageal spasm, and esophageal strictures, based on ICD-9 and CPT codes. Through the use of unique identifiers, patients requiring reintervention were tracked up to 2016 (for at least 8 years follow-up). Primary outcome was incidence of subsequent procedures following HM. Secondary outcomes were time to reintervention and risk factors for reintervention.
Of the 1817 patients who underwent HM, 320 (17.6%) required subsequent intervention. Of the 320 patients, 234 (73.1%) underwent endoscopic reinterventions, 54 (16.9%) underwent minimally invasive procedures, and 32 (10%) underwent resectional procedures as their initial revisional intervention. Of the 234 patients who underwent endoscopic reintervention as their initial revisional procedure, only 40 (16.8%) required subsequent surgical procedures. Over a mean follow-up of 7.0 years, the mean time to a subsequent procedure was 4.3 ± 3.74 years. Reintervention rates after 10 years following HM for achalasia, diverticulum ,and other indication were 24.4%, 12.6%, and 37%, respectively.
The majority of HM reinterventions were managed solely by endoscopic procedures (60.6%). Heller myotomy remains an excellent procedure to prevent surgical reintervention for achalasia and diverticulum.
贲门失弛缓症是一种衰弱性原发性食管动力障碍。Heller 肌切开术（HM）是治疗其他治疗方法失败的贲门失弛缓症患者的一线疗法。HM 的其他适应证包括憩室、弥漫性食管痉挛和食管狭窄。然而，HM 的长期疗效尚不清楚。本研究旨在评估在纽约州接受 HM 治疗的患者再次接受内镜或微创或切除术的干预发生率。
州规划和研究合作系统（SPARCS）行政纵向数据库根据 ICD-9 和 CPT 代码确定了 1817 例 2000 年至 2008 年间因贲门失弛缓症、食管憩室、弥漫性食管痉挛和食管狭窄接受 HM 治疗的成年患者。通过使用唯一标识符，对需要再次干预的患者进行跟踪随访至 2016 年（至少 8 年随访）。主要结局是 HM 后再次手术的发生率。次要结局是再次干预的时间和再次干预的危险因素。
在接受 HM 的 1817 例患者中，有 320 例（17.6%）需要后续干预。在这 320 例患者中，234 例（73.1%）接受了内镜再次干预，54 例（16.9%）接受了微创治疗，32 例（10%）接受了切除术作为初始修正干预。在 234 例接受内镜再次干预作为初始修正手术的患者中，只有 40 例（16.8%）需要后续手术。在平均 7.0 年的随访中，再次手术的平均时间为 4.3±3.74 年。HM 治疗贲门失弛缓症、憩室和其他适应证 10 年后的再干预率分别为 24.4%、12.6%和 37%。
大多数 HM 再次干预仅通过内镜治疗（60.6%）。Heller 肌切开术仍然是预防贲门失弛缓症和憩室手术再次干预的极好方法。
