Suwatthanarak Tharathorn, Phalanusitthepa Chainarong, Thongchuam Chatbadin, Akaraviputh Thawatchai, Chinswangwatanakul Vitoon, Tawantanakorn Thikhamporn, Leelakusolvong Somchai, Maneerattanaporn Monthira, Apisarnthanarak Piyaporn, Wasinrat Jitladda
Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Clin Endosc. 2024 Sep;57(5):610-619. doi: 10.5946/ce.2023.236. Epub 2024 Jun 14.
BACKGROUND/AIMS: Achalasia is a rare esophageal motility disease, for which peroral endoscopic myotomy (POEM) has emerged as a promising treatment option; however, recurrence remains a challenge. Timed barium esophagography (TBE) is a useful diagnostic tool and potential outcome predictor of achalasia. This study aimed to determine predictive tools for recurrence after POEM.
This retrospective study enrolled achalasia patients who underwent POEM between January 2015 and December 2021. Patients were categorized into two groups using the 1-month post-POEM Eckardt scores and TBE: the discordant group (Eckardt score improved >50%, TBE decreased <50%) and the concordant group (both Eckardt score and TBE improved >50%). Recurrence was defined as a reincrease in the Eckardt score to more than three during follow-up.
Complete medical records were available in 30 patients who underwent POEM. Seventeen patients (56.7%) were classified into the discordant group, while 13 patients (43.3%) were in the concordant group. The overall recurrence rate was 11.9% at 1-year, increasing to 23.8% during the extended follow-up. The discordant group had a 6.87 fold higher recurrence rate than the concordant group (52.9% vs. 7.7%, p=0.017).
These results strongly suggest that combining the Eckardt score with TBE can effectively predict recurrent achalasia after POEM. Patients in the discordant group had an elevated risk.
背景/目的：贲门失弛缓症是一种罕见的食管动力障碍性疾病，经口内镜下肌切开术（POEM）已成为一种有前景的治疗选择；然而，复发仍然是一个挑战。定时钡剂食管造影（TBE）是贲门失弛缓症的一种有用的诊断工具和潜在的预后预测指标。本研究旨在确定POEM术后复发的预测指标。
这项回顾性研究纳入了2015年1月至2021年12月期间接受POEM治疗的贲门失弛缓症患者。根据POEM术后1个月的埃卡特评分和TBE将患者分为两组：不一致组（埃卡特评分改善>50%，TBE降低<50%）和一致组（埃卡特评分和TBE均改善>50%）。复发定义为随访期间埃卡特评分再次升高至3分以上。
30例接受POEM治疗的患者有完整的病历资料。17例患者（56.7%）被归类为不一致组，13例患者（43.3%）为一致组。1年时的总体复发率为11.9%，在延长随访期间升至23.8%。不一致组的复发率比一致组高6.87倍（52.9%对7.7%，p=0.017）。
这些结果强烈表明，将埃卡特评分与TBE相结合可以有效预测POEM术后贲门失弛缓症的复发。不一致组患者的风险升高。
