贲门失弛缓症患者经 POEM 治疗的食管自动三维重建：评估治疗效果的一种创新方法。

Automatic three-dimensional reconstruction of the oesophagus in achalasia patients undergoing POEM: an innovative approach for evaluating treatment outcomes.

机构信息

Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany.

University of Augsburg, Augsburg, Germany.

出版信息

BMJ Open Gastroenterol. 2024 Jun 6;11(1):e001396. doi: 10.1136/bmjgast-2024-001396.

DOI:10.1136/bmjgast-2024-001396

PMID:38844375

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11167450/

Abstract

BACKGROUND AND AIMS

Peroral endoscopic myotomy (POEM) is a standard treatment option for achalasia patients. Treatment response varies due to factors such as achalasia type, degree of dilatation, pressure and distensibility indices. We present an innovative approach for treatment response prediction based on an automatic three-dimensional (3-D) reconstruction of the tubular oesophagus (TE) and the lower oesophageal sphincter (LES) in patients undergoing POEM for achalasia.

METHODS

A software was developed, integrating data from high-resolution manometry, timed barium oesophagogram and endoscopic images to automatically generate 3-D reconstructions of the TE and LES. Novel normative indices for TE (volume×pressure) and LES (volume/pressure) were automatically integrated, facilitating pre-POEM and post-POEM comparisons. Treatment response was evaluated by changes in volumetric and pressure indices for the TE and the LES before as well as 3 and 12 months after POEM. In addition, these values were compared with normal value indices of non-achalasia patients.

RESULTS

50 treatment-naive achalasia patients were enrolled prospectively. The mean TE index decreased significantly (p<0.0001) and the mean LES index increased significantly 3 months post-POEM (p<0.0001). In the 12-month follow-up, no further significant change of value indices between 3 and 12 months post-POEM was seen. 3 months post-POEM mean LES index approached the mean LES of the healthy control group (p=0.077).

CONCLUSION

3-D reconstruction provides an interactive, dynamic visualisation of the oesophagus, serving as a comprehensive tool for evaluating treatment response. It may contribute to refining our approach to achalasia treatment and optimising treatment outcomes.

TRIAL REGISTRATION NUMBER

22-0149.

摘要

背景和目的

经口内镜下肌切开术（POEM）是治疗贲门失弛缓症患者的标准治疗选择。由于贲门失弛缓症的类型、扩张程度、压力和可扩张性指数等因素，治疗反应存在差异。我们提出了一种基于贲门失弛缓症患者 POEM 治疗前后管状食管（TE）和食管下括约肌（LES）自动三维（3-D）重建的创新治疗反应预测方法。

方法

开发了一种软件，整合高分辨率测压、定时钡餐食管造影和内镜图像数据，自动生成 TE 和 LES 的 3-D 重建。自动整合 TE（容积×压力）和 LES（容积/压力）的新规范指数，便于术前和术后比较。通过 POEM 前后 TE 和 LES 的容积和压力指数变化来评估治疗反应。此外，将这些值与非贲门失弛缓症患者的正常值指数进行比较。

结果

前瞻性纳入 50 例初治贲门失弛缓症患者。TE 指数显著降低（p<0.0001），POEM 后 3 个月 LES 指数显著升高（p<0.0001）。12 个月随访时，POEM 后 3 至 12 个月之间的数值指数无进一步显著变化。POEM 后 3 个月时 LES 指数接近健康对照组的平均 LES（p=0.077）。