Jacobs Chelsea C, Al-Haddad Mohammad, Stainko Sarah, Perkins Anthony, DeWitt John M
Department of Gastroenterology and Hepatology, Indiana University Health Medical Center, Indianapolis, Indiana, USA.
Department of Biostatistics and Health Data Science, Indiana University Health Medical Center, Indianapolis, Indiana, USA.
Gastrointest Endosc. 2023 Apr;97(4):655-663.e2. doi: 10.1016/j.gie.2022.12.006. Epub 2022 Dec 9.
Chronic narcotic use may cause opioid-induced esophageal dysfunction and associated type III achalasia, hypercontractile esophagus (HE), diffuse esophageal spasm (DES), and esophagogastric junction outflow obstruction (EGJOO). The frequency of opioid use and its impact on peroral endoscopic myotomy (POEM) in these patients is unknown.
Consecutive patients between April 2017 and September 2021 who underwent POEM for type III achalasia, EGJOO, DES, or HE with ≥6 months follow-up were identified. Baseline evaluation was done with EGD, esophageal high-resolution manometry (HRM), and functional lumen impedance planimetry (FLIP) of the esophagogastric junction (EGJ). Eckardt scores (ESs) were calculated at baseline and follow-up at 6 to 12 months after POEM for opioid users and nonusers. Clinical response was defined as ES ≤3, EGJ distensibility index >2.8 mm/mm Hg, maximum EGJ diameter >14 mm, and integrated relaxation pressure (IRP) <15 mm Hg. Opioid use before baseline HRM was assessed.
One hundred twenty-six patients underwent POEM, and 89 had ≥6 months of follow-up. Daily opioid use was present in 18 of 89 patients (20%). Baseline demographics, FLIP metrics, IRP, distribution of motility disorders, and POEM characteristics were similar between both groups. At 6 to 12 months after POEM, clinical response and frequency of GERD, esophagitis, and proton pump inhibitor use were similar between opioid users and nonusers. Heartburn was more frequent in the opioid group (82.4% vs 38.6%, P = .002).
In this single-center study of 89 patients with type III achalasia, EGJOO, DES, or HE treated with POEM, daily opioid use was present in 20%. Response to POEM and post-POEM GERD were similar between opioid users and nonusers. (Clinical trial registration number: NCT02770859.).
长期使用麻醉药品可能导致阿片类药物引起的食管功能障碍以及相关的III型贲门失弛缓症、食管高动力症（HE）、弥漫性食管痉挛（DES）和食管胃交界部流出道梗阻（EGJOO）。这些患者中麻醉药品的使用频率及其对口内镜下肌切开术（POEM）的影响尚不清楚。
确定2017年4月至2021年9月期间连续接受POEM治疗III型贲门失弛缓症、EGJOO、DES或HE且随访时间≥6个月的患者。通过上消化道内镜检查（EGD）、食管高分辨率测压（HRM）和食管胃交界部（EGJ）的功能性管腔阻抗平面测量法（FLIP）进行基线评估。对使用和未使用阿片类药物的患者，在POEM术后6至12个月的基线和随访时计算埃卡德特评分（ES）。临床反应定义为ES≤3、EGJ扩张指数>2.8 mm/mm Hg、最大EGJ直径>14 mm以及综合松弛压（IRP）<15 mm Hg。评估基线HRM之前的阿片类药物使用情况。
126例患者接受了POEM治疗，其中89例有≥6个月的随访。89例患者中有18例（20%）每天使用阿片类药物。两组之间的基线人口统计学、FLIP指标、IRP、运动障碍分布和POEM特征相似。在POEM术后6至12个月，使用和未使用阿片类药物的患者的临床反应以及胃食管反流病（GERD）、食管炎和质子泵抑制剂使用频率相似。阿片类药物组烧心更为常见（82.4%对38.6%，P = .002）。
在这项对89例接受POEM治疗的III型贲门失弛缓症、EGJOO、DES或HE患者的单中心研究中，20%的患者每天使用阿片类药物。使用和未使用阿片类药物的患者对POEM的反应以及POEM术后的GERD情况相似。（临床试验注册号：NCT02770859。）
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