Fukushima Naoko, Masuda Takahiro, Tsuboi Kazuto, Watanabe Jun, Yano Fumiaki
Department of Surgery The Jikei University School of Medicine Tokyo Japan.
Division of Gastroenterological, General and Transplant Surgery, Department of Surgery Jichi Medical University Shimotsuke Tochigi Japan.
Ann Gastroenterol Surg. 2024 Apr 20;8(5):750-760. doi: 10.1002/ags3.12807. eCollection 2024 Sep.
Achalasia is a rare esophageal motility disorder characterized by nonrelaxation of the lower esophageal sphincter. Laparoscopic Heller myotomy (LHM) is the gold standard treatment for achalasia. Peroral endoscopic myotomy (POEM), a less invasive treatment, is performed extensively, and the selection of the intervention method remains debatable to date. In addition to the availability of extensive studies on short-term outcomes, recent studies on the long-term outcomes of LHM and POEM have shown similar clinical success after 5 y of follow-up. However, gastroesophageal reflux disease (GERD) was more common in patients who had undergone POEM than in those who had undergone LHM. Moreover, existing studies have compared treatment outcomes in various disease states. Some studies have suggested that POEM is superior to LHM for patients with type III achalasia because POEM allows for a longer myotomy. Research on treatment for sigmoid types is currently in progress. However, the long-term results comparing LHD and POEM are insufficient, and the best treatment remains controversial. Further research is needed, and treatment options should be discussed with patients and tailored to their individual needs and pathologies.
贲门失弛缓症是一种罕见的食管动力障碍性疾病，其特征为食管下括约肌不松弛。腹腔镜下Heller肌切开术（LHM）是贲门失弛缓症的金标准治疗方法。经口内镜肌切开术（POEM）作为一种侵入性较小的治疗方法，已被广泛应用，而干预方法的选择至今仍存在争议。除了有大量关于短期疗效的研究外，最近关于LHM和POEM长期疗效的研究表明，随访5年后两者的临床成功率相似。然而，与接受LHM的患者相比，接受POEM的患者发生胃食管反流病（GERD）更为常见。此外，现有研究比较了不同疾病状态下的治疗效果。一些研究表明，对于Ⅲ型贲门失弛缓症患者，POEM优于LHM，因为POEM可进行更长的肌切开术。目前正在进行关于乙状结肠型的治疗研究。然而，比较LHD和POEM的长期结果尚不充分，最佳治疗方法仍存在争议。需要进一步研究，应与患者讨论治疗方案，并根据其个体需求和病情进行调整。
