Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, NYU-Winthrop Hospital, Mineola, NY, USA.
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, NYU-Winthrop Hospital, Mineola, NY, USA -
Minerva Gastroenterol (Torino). 2023 Jun;69(2):239-253. doi: 10.23736/S2724-5985.22.03080-7. Epub 2022 Feb 3.
Peroral endoscopic myotomy (POEM) for achalasia (sometimes also referred as E-POEM to distinguish it from its offshoots such as G-POEM for gastroparesis or Z-POEM for Zenker's diverticula) is the newest treatment modality but has already been well validated as a standard intervention for esophageal achalasia. POEM was conceived as a natural orifice transluminal endoscopic surgery (NOTES) procedure with an incisionless, endoscopic approach to myotomy. It matches or exceeds the efficacy of its surgical counterpart, the laparoscopic Heller myotomy, with superiority for type III (spastic) achalasia. However, there are issues, especially regarding GERD after POEM that will likely result in further refinements of technique and post-procedural care. We will summarize the current status of POEM including description of technique variations and review of comparative data vis a vis Heller myotomy (HM) and pneumatic dilation (PD) and we will delve into some of the seminal issues around GERD assessment, management and prevention.
经口内镜下肌切开术（POEM）治疗贲门失弛缓症（有时也称为 E-POEM，以将其与分支区分开来，如治疗胃轻瘫的 G-POEM 或治疗Zenker 憩室的 Z-POEM）是最新的治疗方式，但已被证明是治疗食管失弛缓症的标准介入方法。POEM 的设计理念是一种经自然腔道内镜手术（NOTES）程序，采用无切口、内镜肌切开术。它与腹腔镜 Heller 肌切开术的疗效相当或更优，对于 III 型（痉挛型）失弛缓症具有优势。然而，仍存在一些问题，尤其是 POEM 术后的胃食管反流病（GERD）问题，这可能会导致技术和术后护理的进一步改进。我们将总结 POEM 的现状，包括技术变化的描述，并回顾与 Heller 肌切开术（HM）和气囊扩张术（PD）的比较数据，我们还将深入探讨 GERD 评估、管理和预防方面的一些重要问题。
