Department of Surgery, Upper Gastrointestinal Surgery Unit, Christian Medical College & Hospital, Vellore 632004, Tamilnadu, India.
Department of Cardiothoracic Surgery, Christian Medical College & Hospital, Vellore 632004, Tamilnadu, India.
World J Gastroenterol. 2024 Jun 14;30(22):2834-2838. doi: 10.3748/wjg.v30.i22.2834.
This editorial is an analysis the review article by Nabi recently published in this journal. Achalasia Cardia is a disease whose pathophysiology is still unclear. It is known that there is inflammation of unknown aetiology leading to loss of ganglion cells in the muscularis propria. The end result is lower oesophageal sphincter spasm, loss of receptive relaxation, decreased oesophageal peristalsis, all leading on to varying degrees of dysphagia. The treatment of this condition is palliative in nature, performed by myotomy of the lower oesophagus either surgically or endoscopically. Gastroesophageal reflux disease (GERD) has been associated with the myotomy performed, particularly with the Peroral Endoscopic Myotomy (POEM) procedure. Nabi have provided an excellent overview of the latest developments in predicting, preventing, evaluating, and managing GERD subsequent to POEM. Based on this theme, this review article explores the concept of using histology of the oesophageal muscle layer, to grade the disease and thereby help tailoring the length/type of myotomy performed during the POEM procedure. In the future, will a histology based algorithm available preoperatively, help modify the POEM procedure, thereby decreasing the incidence of GERD associated with POEM?
这篇社论是对 Nabi 最近在本刊发表的综述文章的分析。贲门失弛缓症是一种其病理生理学仍不清楚的疾病。已知存在原因不明的炎症，导致固有肌层神经节细胞丧失。其最终结果是食管下括约肌痉挛、缺乏感受性松弛、食管蠕动减少，所有这些都会导致不同程度的吞咽困难。这种情况的治疗本质上是姑息性的，通过食管下段肌切开术（无论是手术还是内镜下）来进行。胃食管反流病（GERD）与肌切开术有关，特别是经口内镜下肌切开术（POEM）。Nabi 对 POEM 后 GERD 的预测、预防、评估和管理的最新进展提供了极好的概述。基于这一主题，这篇综述文章探讨了使用食管肌肉层组织学来对疾病进行分级的概念，从而有助于针对 POEM 期间进行的肌切开术的长度/类型进行个体化治疗。将来，术前是否可以使用基于组织学的算法来修改 POEM 手术，从而降低与 POEM 相关的 GERD 的发生率？
