Xiang Jingyuan, Chai Ningli, Wang Shasha, Li Longsong, Wang Xiangyao, Linghu Enqiang
Department of Gastroenterology, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
Dis Esophagus. 2023 Jan 28;36(2). doi: 10.1093/dote/doac055.
The efficacy of peroral endoscopic myotomy (POEM) for achalasia has potential associations with Chicago classification by high-resolution manometry (HRM). Type II achalasia demonstrates the best response to POEM of all subtypes, while there remain controversies between type I and type III. Moreover, previous treatment history might cause discrepancy in direct comparison. We aimed to compare the clinical outcome of POEM for type I vs type III in treatment-naive patients. In total, 82 patients with type I or type III achalasia (45 type I, 37 type III) from February 2015 to December 2018 were enrolled and POEM was carried out as the initial treatment. Clinical success, change of Eckardt scores and HRM parameters were analyzed and compared between type I and type III group. About, 43 (95.6%) patients and 34 (91.9%) patients in type I and type III group acquired the clinical success (P = 0.821). Eckardt score and HRM results after POEM treatment decreased significantly in either group (P<0.01). Compared to type III group, higher reduction rates of Eckardt score (type I vs type III, 78.6 vs 66.9%, P = 0.034) and basal LES pressure (type I vs type III, 58.9 vs 40.4%, P = 0.040) were observed in type I group. Type I achalasia patients showed better response to POEM with more favorable clinical remission in Eckardt score and HRM outcomes than type III.
经口内镜下肌切开术（POEM）治疗贲门失弛缓症的疗效与高分辨率测压法（HRM）的芝加哥分类存在潜在关联。II型贲门失弛缓症在所有亚型中对POEM的反应最佳，而I型和III型之间仍存在争议。此外，既往治疗史可能导致直接比较出现差异。我们旨在比较初治患者中I型与III型贲门失弛缓症POEM的临床疗效。2015年2月至2018年12月，共纳入82例I型或III型贲门失弛缓症患者（45例I型，37例III型），并将POEM作为初始治疗方法。分析并比较I型和III型组之间的临床成功率、埃卡特评分变化和HRM参数。I型组约43例（95.6%）患者和III型组约34例（91.9%）患者获得临床成功（P = 0.821）。两组POEM治疗后的埃卡特评分和HRM结果均显著下降（P<0.01）。与III型组相比，I型组埃卡特评分（I型与III型，78.6%对66.9%，P = 0.034）和LES基础压力（I型与III型，58.9%对40.4%，P = 0.040）的降低率更高。I型贲门失弛缓症患者对POEM的反应更好，在埃卡特评分和HRM结果方面的临床缓解情况比III型更有利。
