Department of Internal Medicine, Division of Gastroenterology and Hepatology.
Department of Internal Medicine, Division of Clinical Informatics, Louisiana State University Health Science Center at Shreveport, Shreveport, LA.
Surg Laparosc Endosc Percutan Tech. 2023 Dec 1;33(6):577-582. doi: 10.1097/SLE.0000000000001240.
Peroral endoscopic myotomy (POEM) is a relatively new but increasingly therapeutic option for achalasia. In recent years, POEM has been used for nonachalasia esophageal motility disorders (NAEMDs), such as diffuse esophageal spasm, esophagogastric junction outlet obstruction, and hypercontractile disorder, with some clinical success. No studies thus far compare the outcomes of these two groups. We perform the first head-to-head comparison of outcomes after POEM in patients with achalasia and NAEMD.
A retrospective analysis of all patients undergoing POEM at one university hospital by a single expert endoscopist from July 2021 to December 2022 was performed. All patients were symptomatic, and the presence of esophageal motility disorders was confirmed using multiple diagnostic modalities. These patients were then divided into 2 groups, achalasia and NAEMD, based on the underlying diagnosis. Statistical analysis of different clinical outcomes, including effectiveness and safety, was performed.
Thirty-seven patients (mean age: 59.55, females: 22) underwent POEM in the study period. Twenty patients had achalasia and 17 patients had NAEMD. The median myotomy length was 5.5 cm for the achalasia group and 10 cm for the NAEMD group. This excluded patients with esophagogastric junction outlet obstruction in which the median myotomy length was 3 cm. The procedure time, the duration of hospital stays, the rates of same-day discharge, and complications were similar between the two. Short-term outcomes of POEM for the two groups were similar with improvement in 94% of patients in the achalasia group and 93.75% in the NAEMD group.
Contrary to prior observations, our study highlights that POEM is equally effective in achieving clinical improvement in patients with NAEMD as achalasia over 6 months of follow-up. In addition, POEM has a comparable safety profile in both patient groups making it a feasible therapeutic option for these debilitating and challenging disorders.
经口内镜下肌切开术（POEM）是一种相对较新但越来越有治疗价值的贲门失弛缓症治疗方法。近年来，POEM 已被用于非贲门失弛缓症食管动力障碍性疾病（NAEMD），如弥漫性食管痉挛、食管胃连接部出口梗阻和高收缩性障碍，取得了一定的临床疗效。迄今为止，尚无研究比较这两组患者的结局。我们首次对头对头比较了贲门失弛缓和非贲门失弛缓症患者 POEM 术后的结局。
对 2021 年 7 月至 2022 年 12 月期间由一位专家内镜医生在一家大学医院进行的所有 POEM 患者进行了回顾性分析。所有患者均有症状，并且通过多种诊断方式证实存在食管动力障碍。然后根据基础诊断将这些患者分为贲门失弛缓和非贲门失弛缓症两组。对不同临床结局（包括有效性和安全性）进行了统计学分析。
研究期间，37 名患者（平均年龄：59.55 岁，女性：22 名）接受了 POEM。20 例为贲门失弛缓症，17 例为非贲门失弛缓症。贲门失弛缓症组的肌切开长度中位数为 5.5cm，非贲门失弛缓症组为 10cm。这排除了食管胃连接部出口梗阻患者，其肌切开长度中位数为 3cm。两组的手术时间、住院时间、当天出院率和并发症发生率相似。两组 POEM 的短期结局相似，贲门失弛缓症组 94%的患者和非贲门失弛缓症组 93.75%的患者均得到改善。
与之前的观察结果相反，我们的研究表明，POEM 在 6 个月的随访中，在改善非贲门失弛缓症患者的临床症状方面与贲门失弛缓症同样有效。此外，POEM 在这两组患者中具有相似的安全性，使其成为这些使人衰弱和具有挑战性的疾病的可行治疗选择。
