Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Department of Gastroenterology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
J Dig Dis. 2023 Mar;24(3):224-230. doi: 10.1111/1751-2980.13192. Epub 2023 Jun 22.
To determine whether peroral endoscopic myotomy (POEM) improves esophageal peristalsis and to investigate the association between recovery of esophageal peristalsis after POEM and clinical features of the patients.
In this single-center retrospective study, data were collected from medical records of the patients with achalasia who underwent POEM between January 2014 and May 2016. Demographics data, high-resolution esophageal manometry parameters, Eckardt score, and gastroesophageal reflux disease questionnaire (GERD-Q) score were collected. Weak and fragmented contraction was defined as partial recovery of esophageal peristalsis based on the Chicago classification version 3.0. Logistic regression analysis was used to identify variables associated with the partial recovery of peristalsis after POEM.
A total of 103 patients were enrolled. Esophageal contractile activity was observed in the distal two-thirds of the esophagus in 24 patients. The Eckardt score, integrated relaxation pressure, and lower esophageal sphincter (LES) resting pressure were significantly decreased after POEM. Multivariate analysis revealed that preprocedural LES resting pressure (P = 0.013) and preprocedural Eckardt score (P = 0.002) were related to the partial recovery of peristalsis after POEM. Symptoms of gastroesophageal reflux and reflux esophagitis after POEM were less frequent in those with partial recovery of peristalsis (both P < 0.05).
Normalization of esophagogastric junction relaxation pressure achieved by POEM is associated with the partial recovery of esophageal peristalsis in patients with achalasia. Preprocedural LES resting pressure and the Eckardt score are predictive of the recovery of esophageal peristalsis.
确定经口内镜下肌切开术（POEM）是否能改善食管蠕动，并探讨 POEM 后食管蠕动恢复与患者临床特征的关系。
本单中心回顾性研究收集了 2014 年 1 月至 2016 年 5 月间接受 POEM 的贲门失弛缓症患者的病历资料。收集人口统计学数据、高分辨率食管测压参数、Eckardt 评分和胃食管反流病问卷（GERD-Q）评分。根据芝加哥分类第 3.0 版，将弱收缩和碎裂收缩定义为食管蠕动的部分恢复。采用 logistic 回归分析确定与 POEM 后蠕动部分恢复相关的变量。
共纳入 103 例患者。24 例患者食管远段出现收缩活动。POEM 后 Eckardt 评分、松弛压和食管下括约肌（LES）静息压显著降低。多变量分析显示，术前 LES 静息压（P = 0.013）和术前 Eckardt 评分（P = 0.002）与 POEM 后蠕动的部分恢复有关。POEM 后有部分蠕动恢复的患者胃食管反流和反流性食管炎的症状较少（均 P < 0.05）。
POEM 使食管胃结合部松弛压正常化与贲门失弛缓症患者食管蠕动的部分恢复有关。术前 LES 静息压和 Eckardt 评分是食管蠕动恢复的预测因素。
