Rasmussen Madeline, Ward Marc A, Aladegbami Bola, Ogola Gerald O, Leeds Steven G
Division of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA.
Center for Advanced Surgery, Baylor Scott & White Health, 3417 Gaston Avenue, Suite 965, Dallas, TX, 75246, USA.
Surg Endosc. 2023 Mar;37(3):2347-2353. doi: 10.1007/s00464-023-09872-4. Epub 2023 Jan 19.
Two common surgical procedures used to treat esophageal motility disorders are laparoscopic Heller myotomy (LHM) with partial fundoplication and per-oral endoscopic myotomy (POEM). The difference in frequency of follow-up interventions following these procedures is unknown. This study was designed to report differences in post-surgical interventions as one of the major long-term follow-up expectations.
An IRB approved registry was used to identify all patients undergoing surgery with LHM or POEM. Following surgery, patients requiring additional interventions with esophageal non-pneumatic dilation, botox injection, or repeat myotomy, as well as persistent proton pump inhibitor (PPI) use were recorded. Multivariable logistic regression analysis was performed to estimate risk factors associated with return for additional post-operative intervention.
A total of 203 patients were identified, 139 met inclusion criteria (33 LHM and 106 POEM). There was a higher rate of non-pneumatic EGD dilation (33% vs 15%, p = 0.04), repeat myotomy (18% vs 2%, p < 0.01), and higher rate of overall post-operative intervention in LHM than POEM. With POEM, there was a higher rate of post-operative PPI use (63 vs 29%, p < 0.01). There was no difference in time to post-operative intervention for either group, but if intervention were to occur the median time was within the first year. Patients with a change in pre- to post-operative Eckardt score of 4 or greater decreased their chance of having a post-operative intervention.
Our results for both LHM and POEM emphasize the importance of long-term follow-up in patients with an esophageal motility disorder. We have found that patients undergoing LHM are more likely to have a post-operative intervention as well as a higher rate of repeat myotomy than POEM. With both interventions, a greater change in Eckardt score decreased the likelihood of reintervention.
用于治疗食管动力障碍的两种常见外科手术是腹腔镜Heller肌切开术（LHM）加部分胃底折叠术和经口内镜肌切开术（POEM）。这些手术后随访干预频率的差异尚不清楚。本研究旨在报告作为主要长期随访预期之一的术后干预差异。
使用经机构审查委员会（IRB）批准的登记册来识别所有接受LHM或POEM手术的患者。手术后，记录需要进行食管非气性扩张、肉毒杆菌毒素注射或重复肌切开术等额外干预的患者，以及持续使用质子泵抑制剂（PPI）的情况。进行多变量逻辑回归分析以估计与术后再次干预相关的危险因素。
共识别出203例患者，139例符合纳入标准（33例LHM和106例POEM）。LHM组的非气性内镜下扩张率更高（33%对15%，p = 0.04），重复肌切开术发生率更高（18%对2%，p < 0.01），总体术后干预率也高于POEM组。POEM组术后PPI使用率更高（63%对29%，p < 0.01）。两组术后干预时间无差异，但如果发生干预，中位时间在第一年以内。术前至术后埃卡德评分变化≥4分的患者术后干预机会降低。
我们关于LHM和POEM的研究结果强调了对食管动力障碍患者进行长期随访的重要性。我们发现，与POEM相比，接受LHM手术的患者术后更有可能进行干预，重复肌切开术的发生率也更高。两种干预方式中，埃卡德评分变化越大，再次干预的可能性越小。
