Department of Gastroenterology, The Seventh Medical Center of PLA General Hospital, Nanmencang 5#, Dongcheng District, Beijing, 100700, China.
Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing, China.
BMC Gastroenterol. 2022 May 18;22(1):253. doi: 10.1186/s12876-022-02282-1.
Achalasia is a rare primary esophageal motility disorder disease. It is reported that the long-term effect of fully coated anti-reflux metal stent (FCARMS) implantation is satisfactory. Operated by a skilled and experienced endoscopist, the effect of per-oral endoscopic myotomy (POEM) treatment is equivalent to that of surgical myotomy. So far, there is still few evidence to prove FCARMS implantation or POEM which is better for achalasia. The choice of treatment for achalasia is still controversial. The aim of this study is to find a more suitable therapy for achalasia by comparing the efficacy of FCARMS implantation and POEM.
A propensity score (PS) matching (1:2) was used in this retrospective cohort study. Data collected from consecutive patients of Achalasia, receiving FCARMS implantation or POEM therapy at the department of gastroenterology, the Seventh Medical Center of the Chinese People's Liberation Army General Hospital from May 2007 to May 2018. According to their previous treatment, they are divided into two groups, FCARMS group and POEM group. Clinical efficacy and complications were compared between the two groups.
A total of 166 cases were collected, including 113 cases of FCARMS and 53 cases of POEM. By PS matching, 150 patients were enrolled (100 cases of FCARMS and 50 cases of POEM). By comparison, the FCARMS group has shorter operation time, shorter fasting time and lower hospitalization costs than the POEM group (p < 0.05). Common complications in the FCARMS group are nausea, vomiting, and stent shift. Repetitions of gastroscopy in the FCARMS group was more often, which were 3.8 ± 2.4 (vs 2.1 ± 1.8 of POEM) (p = 0.00 < 0.05) The 6-month remission rates of the FCARMS combination POEM group were 89% and 94%, respectively (p = 0.39), and the 2-year remission rates were 61% and 90%, respectively (p = 0.00).
Stent placement is a cost-effective and safe treatment option for achalasia. The short-term effect (less than 6 months) of FCARMS is similar to that of POEM, the long-term effect (more than 2 years), POEM is better than FCARMS. HRMIIis most suitable for POEM treatment. It indicate that Patients can choose treatment methods according to their own conditions.
贲门失弛缓症是一种罕见的原发性食管动力障碍性疾病。有报道称，完全涂层抗反流金属支架（FCARMS）植入的长期效果令人满意。由经验丰富的内镜医生操作，经口内镜肌切开术（POEM）的治疗效果与手术肌切开术相当。迄今为止，尚无证据证明 FCARMS 植入或 POEM 更适合治疗贲门失弛缓症。贲门失弛缓症的治疗选择仍存在争议。本研究旨在通过比较 FCARMS 植入和 POEM 的疗效，找到更适合治疗贲门失弛缓症的方法。
本回顾性队列研究采用倾向评分（PS）匹配（1:2）。收集 2007 年 5 月至 2018 年 5 月在解放军总医院第七医学中心消化科接受 FCARMS 植入或 POEM 治疗的贲门失弛缓症连续患者的数据。根据他们之前的治疗方法，将他们分为 FCARMS 组和 POEM 组。比较两组的临床疗效和并发症。
共收集 166 例，其中 FCARMS 组 113 例，POEM 组 53 例。通过 PS 匹配，共纳入 150 例患者（FCARMS 组 100 例，POEM 组 50 例）。与 POEM 组相比，FCARMS 组的手术时间更短、禁食时间更短、住院费用更低（p<0.05）。FCARMS 组常见的并发症有恶心、呕吐和支架移位。FCARMS 组需要重复行胃镜检查的次数更多，为 3.8±2.4 次（POEM 组为 2.1±1.8 次）（p=0.00<0.05）。FCARMS 联合 POEM 组的 6 个月缓解率分别为 89%和 94%（p=0.39），2 年缓解率分别为 61%和 90%（p=0.00）。
支架置入是治疗贲门失弛缓症的一种具有成本效益且安全的治疗选择。FCARMS 的短期效果（<6 个月）与 POEM 相似，长期效果（>2 年），POEM 优于 FCARMS。HRMII 最适合 POEM 治疗。这表明患者可以根据自己的情况选择治疗方法。
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