Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Ann Surg. 2021 Jun 1;273(6):1135-1140. doi: 10.1097/SLA.0000000000004830.
We aim to describe the long-term follow-up data from our institution's POEM experience.
Per-oral endoscopic myotomy (POEM) is a well-established endoscopic therapy for achalasia with excellent short-term efficacy, but long-term outcomes data are limited.
Patients older than 4 years removed from POEM for treatment of achalasia were studied. Clinical success was defined as an Eckardt Symptom (ES) score ≤3 and freedom from reintervention for achalasia. Patients underwent esophagogastroduodenoscopy (EGD), high-resolution manometry, impedance planimetry, and timed barium esophagram (TBE) preoperatively and at least 4 years postoperatively. Objective gastroesophageal reflux disease (GERD) was defined LA Grade B or worse esophagitis on EGD.
One hundred and nineteen consecutive patients were included. Five patients died or had catastrophic events unrelated to achalasia or POEM. One hundred of the remaining patients (88%, 100/114) had long-term data available. Clinical follow-up for all patients was greater than 4 years postoperatively and the mean was 55 months. Mean current ES was significantly improved from preop (n = 100, 1 ± 1 vs 7 ± 2, P < 0.001). Overall clinical success was 88% and 92%. Five patients had a current ES >3 and 4 patients required procedural reintervention on the lower esophageal sphincter. Reinterventions were successful in 75% of patients (3/4), with current ES ≤3. The rate of objective GERD was 33% (15/45). Esophageal physiology was improved with a decrease in median integrated relaxation pressure (11 ± 4 vs 33 ± 15 mm Hg, P < 0.001), a decrease in median TBE column height (3 ± 3 vs 13 ± 8 cm, P < 0.001), and an increase in median distensibility index (5.1 ± 2 vs 1.1 ± 1 mm2/mm Hg, P < 0.001).
POEM provides durable symptom relief and improvement in physiologic esophagogastric junction relaxation parameters over 4.5 years postoperatively. Reinterventions are rare and effective.
我们旨在描述本机构 POEM 经验的长期随访数据。
经口内镜下肌切开术（POEM）是一种成熟的贲门失弛缓症内镜治疗方法，具有极好的短期疗效，但长期结果数据有限。
研究了年龄大于 4 岁并因贲门失弛缓症接受 POEM 治疗的患者。临床成功定义为 Eckardt 症状（ES）评分≤3 且无需再次手术干预贲门失弛缓症。患者术前和术后至少 4 年接受食管胃十二指肠镜检查（EGD）、高分辨率测压、阻抗平面测量和时间分辨钡食管造影（TBE）。客观胃食管反流病（GERD）定义为 EGD 上 LA 分级 B 或更严重的食管炎。
共纳入 119 例连续患者。5 例患者死亡或发生与贲门失弛缓和 POEM 无关的灾难性事件。100/114（88%）例患者有长期数据可用。所有患者的临床随访时间均超过术后 4 年，平均随访时间为 55 个月。目前的 ES 均值明显优于术前（n=100，1±1 比 7±2，P＜0.001）。总体临床成功率为 88%和 92%。5 例患者目前的 ES＞3，4 例患者需要对食管下括约肌进行程序性再干预。75%（3/4）例患者的再干预成功，目前的 ES≤3。客观 GERD 的发生率为 33%（15/45）。食管生理功能得到改善，中位综合松弛压力（11±4 比 33±15mmHg，P＜0.001）、中位 TBE 柱高（3±3 比 13±8cm，P＜0.001）和中位扩张指数（5.1±2 比 1.1±1mmHg/mm，P＜0.001）降低。
POEM 提供持久的症状缓解，并改善术后 4.5 年的生理食管胃结合部松弛参数。再干预很少见且有效。
