Nabi Zaheer, Nageshwar Reddy D
Asian institute of Gastroenterology, Hyderabad, India.
Front Med (Lausanne). 2022 Aug 18;9:948299. doi: 10.3389/fmed.2022.948299. eCollection 2022.
Peroral endoscopic myotomy (POEM) is an established frontline treatment modality for achalasia cardia. Since its initial description, several modifications have been proposed to the technique of POEM. Broadly speaking, these modifications follow the basic principles of submucosal endoscopy, but incorporate variations in the POEM technique, including the difference in the orientation of myotomy (anterior or posterior), length of myotomy (short or long), and thickness of myotomy (selective circular or full thickness). Some of these modifications have been shown to reduce procedural duration without compromising the efficacy of the POEM procedure. More recently, several alterations have been reported that intend to reduce gastroesophageal reflux after POEM. These include preservation of sling fibers during posterior POEM and addition of NOTES fundoplication to the POEM procedure. Although some of the modified techniques have been compared with the conventional techniques in quality trials, randomized studies are awaited for others. The incorporation of some of these modifications will likely make POEM a technically easy and safer modality in near future. This review aims to discuss the current evidence with regard to the impact of modified techniques on the outcome of POEM.
经口内镜下肌切开术（POEM）是贲门失弛缓症既定的一线治疗方式。自首次描述以来，人们对POEM技术提出了多种改进方法。广义而言，这些改进遵循了黏膜下内镜检查的基本原则，但在POEM技术中融入了各种变化，包括肌切开术方向（前或后）、肌切开术长度（短或长）以及肌切开术厚度（选择性环形或全层）的差异。其中一些改进已被证明可缩短手术时间，同时不影响POEM手术的疗效。最近，有报道称一些改进旨在减少POEM术后的胃食管反流。这些改进包括在后路POEM手术中保留吊带纤维以及在POEM手术中增加NOTES胃底折叠术。尽管在质量试验中已将一些改良技术与传统技术进行了比较，但其他技术仍有待随机对照研究。纳入其中一些改进可能会使POEM在不久的将来成为一种技术上更简便、更安全的治疗方式。本综述旨在讨论关于改良技术对POEM手术效果影响的当前证据。
