Division of Gastroenterology, Hepatology & Nutrition, NYU-Winthrop Hospital, Mineola, New York, USA.
Department of Medicine, Mt Sinai St Luke's-West Hospital Center, New York, New York, USA.
Gastrointest Endosc. 2021 Nov;94(5):930-942. doi: 10.1016/j.gie.2021.05.014. Epub 2021 May 12.
Peroral endoscopic myotomy (POEM) is becoming the treatment of choice for achalasia. Data beyond 3 years are emerging but are limited. We herein report our 10-year experience, focusing on long-term efficacy and safety including the prevalence, management, and sequelae of postoperative reflux.
This was a single-center prospective cohort study.
Six hundred ten consecutive patients received POEM from October 2009 to October 2019, 160 for type 1 achalasia (26.2%), 307 for type II (50.3%), 93 for type III (15.6%), 25 for untyped achalasia (4.1%), and 23 for nonachalasia disorders (3.8%). Two hundred ninety-two patients (47.9%) had prior treatment(s). There was no aborted POEM. Median operation time was 54 minutes. Accidental mucosotomies occurred in 64 patients (10.5%) and clinically significant adverse events in 21 patients (3.4%). No adverse events led to death, surgery, interventional radiology interventions/drains, or altered functional status. At a median follow-up of 30 months, 29 failures occurred, defined as postoperative Eckardt score >3 or need for additional treatment. The Kaplan-Meier clinical success estimates at years 1, 2, 3, 4, 5, 6, and 7 were 98%, 96%, 96%, 94%, 92%, 91%, and 91%, respectively. These are highly accurate estimates because only 13 patients (2%) were missing follow-up assessments. One hundred twenty-five patients (20.5%) had reflux symptoms more than once per week. At a median of 4 months, the pH study was completed in 406 patients (66.6%) and was positive in 232 (57.1%), and endoscopy was completed in 438 patients (71.8%) and showed reflux esophagitis in 218 (49.8%), mostly mild.
POEM is exceptionally safe and highly effective on long-term follow-up, with >90% clinical success at ≥5 years.
经口内镜下肌切开术（POEM）已成为贲门失弛缓症的首选治疗方法。目前已有超过 3 年的数据，但数量有限。本研究报告了我们 10 年的经验，重点关注长期疗效和安全性，包括术后反流的发生率、处理方法和后遗症。
这是一项单中心前瞻性队列研究。
2009 年 10 月至 2019 年 10 月，610 例连续患者接受了 POEM 治疗，其中 160 例为 1 型贲门失弛缓症（26.2%），307 例为 2 型（50.3%），93 例为 3 型（15.6%），25 例为未分型贲门失弛缓症（4.1%），23 例为非贲门失弛缓症（3.8%）。292 例（47.9%）患者有既往治疗史。无 POEM 术中转开腹。中位手术时间为 54 分钟。64 例（10.5%）发生意外黏膜切开，21 例（3.4%）发生有临床意义的不良事件。无不良事件导致死亡、手术、介入放射学干预/引流或功能状态改变。中位随访 30 个月时，29 例（4.8%）发生术后失败，定义为术后 Eckardt 评分>3 分或需要额外治疗。术后 1、2、3、4、5、6 和 7 年的 Kaplan-Meier 临床成功率估计分别为 98%、96%、96%、94%、92%、91%和 91%。这些是非常准确的估计，因为只有 13 例（2%）患者失访。125 例（20.5%）患者每周有超过 1 次的反流症状。中位随访 4 个月时，406 例（66.6%）患者完成 pH 研究，其中 232 例（57.1%）为阳性，438 例（71.8%）患者完成内镜检查，218 例（49.8%）有反流性食管炎，大多为轻度。
POEM 是一种非常安全且非常有效的治疗方法，长期随访效果良好，≥5 年的临床成功率超过 90%。
