Hew Simon, Motomura Douglas, Bechara Robert
Monash Medical Centre Clayton, Gastroenterology and Hepatology, Clayton, VIC, AUS.
Queen's University, Department of Medicine, Kingston, ON, CAN.
Endosc Int Open. 2021 Sep 16;9(10):E1491-E1496. doi: 10.1055/a-1520-0016. eCollection 2021 Oct.
Weight loss is a feature of untreated achalasia. While weight gain after achalasia treatment is expected, little data exist about the extent of it, particularly after peroral endoscopic myotomy (POEM). We aimed to describe the changes in weight after POEM. A retrospective analysis was performed of patients from March 2016 to March 2020 undergoing POEM by an experienced operator at an academic referral center in Kingston, Ontario, Canada. Data examined included pre- and post-POEM body mass index (BMI), procedural characteristics, and Eckardt scores. Ninety-two patients underwent POEM during the study period, for 77 of whom follow-up data were available including BMI. Prior to POEM, the median BMI was 26. Six patients (7.8 %) were considered to be underweight, 24 (31.2 %) were normal, 26 (33.8 %) were pre-obese, and 21 (27.2 %) were obese. At a median follow-up of 15 months, the clinical success rate was 95 %. Patients in the normal weight and pre-obesity categories had a significant increase in weight post-POEM. Of the underweight patients, two (33.3 %) moved up to a normal weight category and two (33.3 %) became pre-obese. In the normal BMI category, eight (37.5 %) became pre-obese and one patient (4.2 %) became obese. Ten of the 26 pre-obese patients (38.4 %) were obese post-POEM. Seven of the obese patients (33.3 %) reached Class III (morbid) obesity at follow-up. Patients may experience a marked increase in BMI following POEM, with over one-third of patients becoming pre-obese, obese or morbidly obese at follow-up in our study in a North American population. Further study is required to analyze weight gain patterns post-POEM.
体重减轻是未经治疗的贲门失弛缓症的一个特征。虽然贲门失弛缓症治疗后体重增加是预期的，但关于其增加程度的数据很少，尤其是在经口内镜下肌切开术（POEM）之后。我们旨在描述POEM术后体重的变化。对2016年3月至2020年3月期间在加拿大安大略省金斯顿一家学术转诊中心由经验丰富的操作者进行POEM手术的患者进行了回顾性分析。检查的数据包括POEM术前和术后的体重指数（BMI）、手术特征和埃卡德特评分。在研究期间，92例患者接受了POEM手术，其中77例有包括BMI在内的随访数据。POEM术前，BMI中位数为26。6例患者（7.8%）被认为体重过轻，24例（31.2%）体重正常，26例（33.8%）为肥胖前期，21例（27.2%）为肥胖。在中位随访15个月时，临床成功率为95%。体重正常和肥胖前期的患者在POEM术后体重显著增加。在体重过轻的患者中，2例（33.3%）升至体重正常类别，2例（33.3%）变为肥胖前期。在BMI正常类别中，8例（37.5%）变为肥胖前期，1例患者（4.2%）变为肥胖。26例肥胖前期患者中有10例（38.4%）在POEM术后变为肥胖。7例肥胖患者（33.3%）在随访时达到III级（病态）肥胖。在我们对北美人群的研究中，患者在POEM术后可能会出现BMI显著增加，超过三分之一的患者在随访时变为肥胖前期、肥胖或病态肥胖。需要进一步研究来分析POEM术后的体重增加模式。
