Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, School of Medicine, Clinica Chirurgica 3, Azienda Ospedale Università di Padova, Padova, Italy.
J Gastrointest Surg. 2021 Sep;25(9):2201-2207. doi: 10.1007/s11605-021-05021-1. Epub 2021 May 6.
The treatment of esophagogastric junction outflow obstruction (EGJOO) currently mirrors that of achalasia, but this is based on only a few studies on small case series. The aim of this prospective, controlled study was to assess the outcome of laparoscopic Heller-Dor (LHD) in patients with EGJOO, as compared with patients with esophageal achalasia.
Between 2016 and 2019, patients with manometric diagnosis of idiopathic EGJOO and patients with radiological stage I achalasia, both treated with LHD, were compared. The achalasia group was further analyzed by subgrouping the patients based on the manometric pattern. Treatment failure was defined as the persistence or reoccurrence of an Eckardt score > 3 or the need for retreatment.
During the study period, 150 patients were enrolled: 25 patients had EGJOO and 125 had radiological stage I achalasia (25 pattern I, 74 pattern II, and 26 pattern III). The median follow-up was 24 months (IQR: 34-16). Treatment was successful in 96% of patients in the EGJOO group and in 96% of achalasia patients with pattern I, 98.7% in those with pattern II, and 96.2% of those with pattern III (p=0.50). High-resolution manometry showed a reduction in the LES resting pressure and integrated relaxation pressure for all patients in all 4 groups (p<0.001).
This is the first comparative study based on prospective data collection to assess the outcome of LHD in patients with EGJOO. LHD emerged as an effective treatment for EGJOO, with an excellent success rate, comparable with the procedure's efficacy in treating early-stage achalasia.
目前，胃食管结合部流出道梗阻（EGJOO）的治疗方法类似于贲门失弛缓症，但这仅基于少数关于小病例系列的研究。本前瞻性、对照研究的目的是评估腹腔镜 Heller-Dor （LHD）治疗 EGJOO 患者的效果，并与食管失弛缓症患者进行比较。
2016 年至 2019 年，对经测压诊断为特发性 EGJOO 的患者和接受 LHD 治疗的放射学 I 期贲门失弛缓症患者进行比较。根据测压模式对贲门失弛缓症组患者进行亚组分析。治疗失败定义为 Eckardt 评分>3 或需要再次治疗。
在研究期间，共纳入 150 例患者：25 例为 EGJOO 患者，125 例为放射学 I 期贲门失弛缓症患者（25 例为 I 型，74 例为 II 型，26 例为 III 型）。中位随访时间为 24 个月（IQR：34-16）。EGJOO 组患者的治疗成功率为 96%，I 型贲门失弛缓症患者的治疗成功率为 96%，II 型为 98.7%，III 型为 96.2%（p=0.50）。高分辨率测压显示所有 4 组患者的食管下括约肌静息压和整体松弛压均降低（p<0.001）。
这是第一项基于前瞻性数据收集的比较研究，旨在评估 LHD 治疗 EGJOO 患者的效果。LHD 是一种有效的治疗 EGJOO 的方法，成功率高，与治疗早期贲门失弛缓症的疗效相当。
