Peng Dongzi, Tan Yuyong, Li Chenjie, Lv Liang, Zhu Hongyi, Liang Chengbai, Li Rong, Liu Deliang
Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China.
Research Center of Digestive Disease, Central South University, Changsha, China.
Front Pediatr. 2022 Apr 4;10:845103. doi: 10.3389/fped.2022.845103. eCollection 2022.
Peroral endoscopic myotomy (POEM) has shown promising short-term safety and efficacy in pediatric patients, while long-term outcomes are largely unknown. This study aimed to assess the clinical effects of POEM for pediatric achalasia who had a follow-up of at least 5 years.
Pediatric patients from a single center who underwent a POEM between October 2011 and November 2016 were, respectively, collected and analyzed for long-term clinical outcomes. Patients were contacted to evaluate their current symptoms and encouraged repeat endoscopy and manometry. The clinical success, procedure-related parameters, adverse events, gastroesophageal reflux disease after POEM, and quality of life were evaluated.
A total of twenty-four patients who underwent POEM in our center were studied, with a mean age of 14.42 ± 2.65. Two of the 24 patients (8.3%) had previous treatment. The mean of the procedure time was 58.67 ± 19.10 min, 8.3% (2/24) of patients experienced perioperative adverse events. The current symptom scores were obtained from 21 patients at a mean follow-up of 92.57 months, the remainder were lost to follow-up after a mean of 38 months. Eckardt scores were significantly improved from preoperative baseline (preoperative 7.67 ± 1.62 vs. current 0.86 ± 1.28, < 0.001). Long-term overall success was achieved in 95.8% of patients and none required retreatment for symptoms. 12.5% of patients were suffered from clinical reflux. 76.2% of patients expressed satisfaction with POEM. No severe adverse events were observed during the operation and the 5-years follow-up.
POEM resulted in successful symptomatic mitigation in a majority of pediatric patients after 5 years. A multi-center large-scale, prospective study is necessary for a confirmed conclusion.
经口内镜下肌切开术（POEM）在儿科患者中已显示出良好的短期安全性和疗效，但长期结果在很大程度上尚不清楚。本研究旨在评估POEM对随访至少5年的小儿贲门失弛缓症患者的临床效果。
收集2011年10月至2016年11月在单一中心接受POEM的儿科患者，分析其长期临床结果。与患者联系以评估他们目前的症状，并鼓励他们再次进行内镜检查和测压。评估临床成功率、手术相关参数、不良事件、POEM术后胃食管反流病以及生活质量。
本中心共研究了24例接受POEM的患者，平均年龄为14.42±2.65岁。24例患者中有2例（8.3%）曾接受过治疗。手术时间平均为58.67±19.10分钟，8.3%（2/24）的患者发生围手术期不良事件。在平均随访92.57个月时从21例患者获得了当前症状评分，其余患者在平均38个月后失访。埃卡德特评分较术前基线有显著改善（术前7.67±1.62 vs. 当前0.86±1.28，<0.001）。95.8%的患者获得长期总体成功，且无一例因症状需要再次治疗。12.5%的患者出现临床反流。76.2%的患者对POEM表示满意。手术期间及5年随访期间未观察到严重不良事件。
POEM使大多数儿科患者在5年后症状成功缓解。需要进行多中心大规模前瞻性研究以得出确切结论。
