Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, 44106, USA.
Department of Surgery, Case Western Reserve University, Cleveland, OH, USA.
Surg Endosc. 2023 Sep;37(9):7226-7229. doi: 10.1007/s00464-023-10249-w. Epub 2023 Jun 30.
While per oral endoscopic myotomy (POEM) has been shown to be efficacious in the treatment of achalasia, it can be difficult to predict who will have a robust and durable response. Historically, high lower esophageal sphincter pressures have been shown to predict a worse response to endoscopic therapies such as botox therapy. This study was designed to evaluate if modern preoperative manometric data could predict a response to therapy after POEM.
This was a retrospective study of 144 patients who underwent a POEM at a single institution by a single surgeon over an 8-year period (2014-2022) who had high-resolution manometry performed preoperatively and had an Eckardt symptom score performed both preoperatively and postoperatively. The achalasia type and integrated relaxation pressures (IRP) were then tested for potential correlation with need for any further achalasia interventions postoperatively as well as the degree of Eckardt score reduction using univariate analysis.
The achalasia type on preoperatively manometry was not predictive of need for further interventions or degree of Eckardt score reduction (p = 0.74 and 0.44, respectively). A higher IRP was not predictive of need for further interventions however it was predictive of a greater reduction in postoperative Eckardt scores (p = 0.03) as shown by a nonzero regression slope.
In this study, achalasia type was not a predictive factor in need for further interventions or degree of symptom relief. While IRP was not predictive of need for further interventions, a higher IRP did predict better symptomatic relief postoperatively. This result is opposite that of other endoscopic treatment modalities. Therefore, patients with higher IRP on high-resolution manometry would likely benefit from myotomy which provides significant symptomatic relief postoperatively.
经口内镜下肌切开术（POEM）已被证明在治疗贲门失弛缓症方面有效，但很难预测哪些患者会获得显著且持久的疗效。既往研究显示，食管下括约肌压力较高与肉毒毒素等内镜治疗的反应较差相关。本研究旨在评估现代术前测压数据是否可预测 POEM 后的治疗反应。
这是一项回顾性研究，纳入了 144 例在单中心接受单一术者的 POEM 治疗的患者，该研究于 8 年内（2014-2022 年）进行，所有患者术前均行高分辨率测压，且术前和术后均行 Eckardt 症状评分。然后，使用单变量分析测试贲门失弛缓症类型和整体松弛压（IRP）与术后是否需要进一步治疗以及 Eckardt 评分降低程度的相关性。
术前测压的贲门失弛缓症类型与是否需要进一步干预或 Eckardt 评分降低程度无关（p 值分别为 0.74 和 0.44）。较高的 IRP 与是否需要进一步干预无关，但与术后 Eckardt 评分的降低程度相关（p=0.03），表现为非零回归斜率。
在本研究中，贲门失弛缓症类型不是进一步干预或症状缓解程度的预测因素。尽管 IRP 与进一步干预的需要无关，但较高的 IRP 确实预示着术后症状的更好缓解。这一结果与其他内镜治疗方式相反。因此，高分辨率测压中 IRP 较高的患者可能会从肌切开术中获益，后者可在术后提供显著的症状缓解。
