Department of Medicine Haukeland University Hospital Jonas Lies vei 65 5021 Bergen.
Norway Department of Clinical Medicine University of Bergen Bergen Norway.
Scand J Surg. 2023 Mar;112(1):3-10. doi: 10.1177/14574969221139706. Epub 2022 Dec 9.
Per oral endoscopic myotomy (POEM) has become an established treatment for achalasia, but no Scandinavian studies with long-term follow-up exist. This study from a tertiary referral center in Norway investigates the short-, mid-, and long-term feasibility, safety, efficacy, and complications of POEM.
Prospective data from the first 84 patients who underwent POEM from 2014 to 2019 were analyzed. The median follow-up time was 44 months. Clinical success was defined as the Eckardt score (ES) ⩽3, and reflux as pathological if the acid exposure time (pH < 4) was more than 6%. ES was used for symptom evaluation before, and at 6, 12, and up to 64 months after POEM.
A total of 50 males and 34 females were included. A total of 43 (51%) were treatment naïve, 24 (28.6%) had been previously treated with botulinum toxin, pneumatic balloon dilatation, or both, and 17 (20.2%) were previously treated with Heller's myotomy. The median post-POEM ES at 12 months was 1 (0-9), compared to pre-POEM 7 (4-12) (p < 0.01). At 12 months after POEM, clinical success persisted in 74 patients (88.1%). Clinical success was the highest for patients who were naïve to treatment, 41/43 (95%), and lower for those previously treated with Heller's myotomy 12/17 (70.6%). Long-term follow-up at 5-6 years of 42 patients showed a clinical success rate of 94%. We experienced adverse events in five patients (6%). Post-POEM pathological reflux was found in 46% (28/61). After 3-4 years, the median ES was 1, and after 5-6 years, it was 2.
POEM was safe and relieved the symptoms of achalasia significantly and persistently. The procedure had a better outcome in treatment naïve than previously treated patients. However, POEM is associated with significantly increased esophageal acid exposure.
Norwegian single-center study: POEM had a clinical success rate of 94% after 5-6 years since its introduction at the center in 2014, providing a safe and effective treatment for achalasia.
经口内镜下肌切开术（POEM）已成为贲门失弛缓症的一种既定治疗方法，但目前尚无来自斯堪的纳维亚国家的长期随访研究。本研究来自挪威的一家三级转诊中心，旨在调查 POEM 的短期、中期和长期可行性、安全性、疗效和并发症。
对 2014 年至 2019 年间接受 POEM 的 84 例患者的前瞻性数据进行了分析。中位随访时间为 44 个月。临床成功定义为 Eckardt 评分（ES） ⩽3，反流如果酸暴露时间（pH<4）超过 6%则为病理性。ES 用于 POEM 前、后 6、12 和长达 64 个月时的症状评估。
共纳入 50 名男性和 34 名女性。43 例（51%）为治疗初治患者，24 例（28.6%）曾接受过肉毒杆菌毒素、气动球囊扩张或两者联合治疗，17 例（20.2%）曾接受过 Heller 肌切开术治疗。12 个月时 POEM 后 ES 中位数为 1（0-9），而 POEM 前为 7（4-12）（p<0.01）。POEM 后 12 个月，74 例患者（88.1%）临床成功。初治患者的临床成功率最高，为 41/43（95%），而 Heller 肌切开术治疗后患者的临床成功率较低，为 12/17（70.6%）。42 例患者的 5-6 年长期随访显示临床成功率为 94%。我们在 5 例患者（6%）中观察到不良事件。46%（28/61）的患者在 POEM 后出现病理性反流。3-4 年后，ES 中位数为 1，5-6 年后，ES 中位数为 2。
POEM 安全且能显著持久地缓解贲门失弛缓症的症状。与之前接受过治疗的患者相比，初治患者的手术效果更好。然而，POEM 与显著增加的食管酸暴露相关。
挪威单中心研究：POEM 在 2014 年引入该中心后，5-6 年后的临床成功率为 94%，为贲门失弛缓症提供了一种安全有效的治疗方法。
Zotero 插件