经口内镜肌切开术治疗贲门失弛缓症患者一年的综合前瞻性随访。
One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy.
机构信息
Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
出版信息
Ann Med. 2021 Dec;53(1):2225-2233. doi: 10.1080/07853890.2021.2005253.
BACKGROUND AND AIMS
Peroral endoscopic myotomy (POEM) is an established therapy for achalasia, but outcome evaluation has often been limited to Eckardt score (ES). The present study was aimed to improve knowledge about outcome evaluation and predictive outcome factors by performing a comprehensive objective evaluation of achalasia patients treated by POEM.
METHODS
This single centre prospective study reports outcome data 12 months after POEM in treatment-naive achalasia patients. A predefined follow-up protocol included ES, high resolution manometry, 24-h pH measurement, upper endoscopy and timed barium esophagogram (TBE). Univariate and multivariate regression analyses were performed to analyze association between post-POEM variables and identify predictive factors for objective outcome.
RESULTS
Fifty patients were included with a drop-out rate of <5%. ES, lower oesophageal sphincter pressures, TBE heights and maximal oesophageal diameter were all reduced after POEM ( < .001), and 28% (13/47) of the patients had a positive 24-h pH registration. An oesophageal diameter >3 cm after POEM was associated with treatment failure assessed by ES ( = .04) and TBE ( = .03). Advanced achalasia stage ( = .02) and long symptom duration ( = .04) were identified as independent predictive factors for poor outcome assessed by TBE.
CONCLUSIONS
The present study confirms that POEM is an efficient therapy for achalasia. The comprehensive objective evaluation after POEM demonstrates that long symptom duration and major changes in oesophageal anatomy at diagnosis imply poor treatment outcome, and a post-POEM dilated oesophagus is associated with treatment failure.Key messagesPeroral endoscopic myotomy (POEM) is established as a safe and effective therapy for achalasia.Timed barium esophagogram offers objective variables that are valuable in treatment response evaluation. Advanced achalasia stage and long symptom duration are predictive factors for poor objective treatment response after POEM.
背景与目的
经口内镜下肌切开术（POEM）是治疗贲门失弛缓症的一种成熟疗法，但疗效评估往往仅限于 Eckardt 评分（ES）。本研究旨在通过对接受 POEM 治疗的贲门失弛缓症患者进行全面的客观评估，进一步了解疗效评估和预测疗效的因素。
方法
这是一项单中心前瞻性研究，报告了 POEM 治疗后 12 个月治疗初治贲门失弛缓症患者的结果数据。一项预设的随访方案包括 ES、高分辨率测压、24 小时 pH 测量、上消化道内镜检查和时间分辨钡餐食管造影（TBE）。进行单变量和多变量回归分析，以分析 POEM 后变量与客观结果之间的关系，并确定客观结果的预测因素。
结果
共有 50 例患者入组，失访率<5%。POEM 后 ES、食管下括约肌压力、TBE 高度和食管最大直径均降低（均<0.001），28%（13/47）的患者 24 小时 pH 监测阳性。POEM 后食管直径>3cm 与 ES（=0.04）和 TBE（=0.03）评估的治疗失败相关。晚期贲门失弛缓症（=0.02）和较长的症状持续时间（=0.04）是 TBE 评估的不良预后的独立预测因素。
结论
本研究证实 POEM 是治疗贲门失弛缓症的有效方法。POEM 后的全面客观评估表明，较长的症状持续时间和诊断时食管解剖结构的重大变化提示治疗效果不佳，POEM 后食管扩张与治疗失败相关。
关键信息
经口内镜下肌切开术（POEM）已确立为治疗贲门失弛缓症的安全有效方法。时间分辨钡餐食管造影提供了有价值的治疗反应评估的客观变量。晚期贲门失弛缓症和较长的症状持续时间是 POEM 后客观治疗反应不良的预测因素。
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