Bapaye Amol, Yewale Rohan, Shah Jimil, Bale R Ajay, Ansari Jaseem, Borkar Mangesh, Bapaye Harsh, Pujari Rajendra, Gadhikar Harshal
Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India.
Gastrointest Endosc. 2025 Apr 25. doi: 10.1016/j.gie.2025.04.029.
Peroral endoscopic myotomy (POEM) is well established for the treatment of achalasia. Post-POEM gastroesophageal reflux (GER) has been identified as a concern. Concomitant endoscopic fundoplication (POEM + F) may reduce post-POEM GER. This study compares composite (objective and subjective) GER outcomes at 3 years' follow-up in a matched cohort of patients with achalasia undergoing POEM versus POEM + F.
This single-center, retrospective, matched cohort study compared POEM + F versus POEM. It used retrospective matching with criteria as follows: age, sex, body mass index, achalasia type, prior interventions, and American Society of Anesthesiologists status. Baseline characteristics, pre/postprocedure Eckardt scores (ESs), technical aspects, and AEs were recorded. Both groups were followed up annually for 3 years. Outcomes were compared at 3 years. The primary outcome was the incidence of objective GER (Lyon Consensus 2.0); and secondary outcomes were subjective (symptomatic) GER (GERD questionnaire, Reflux Symptom Index, GERD health-related quality of life), and clinical success (ES <3). P < .05 was considered significant.
Thirty-four POEM + F patients were matched to 34 POEM patients (total consecutive POEM + F = 41; excluded = 7 [technical failure, = 2; unsuitable match, = 5]). AEs included mucosal injury (POEM vs POEM-F, 11.8% vs 8.8%; P = .69). One recurrence (POEM + F) at 9 months was excluded for long-term follow-up. At the 3-year follow-up, objective GER (esophageal acid exposure time >6% and/or Grade B or higher esophagitis) was observed in 2 (13.3%) of 15 patients (POEM + F) versus 7 (58.3%) of 12 (POEM) (P = .037). Wrap integrity was maintained in 76.5% of POEM + F cases at 3 years. Symptomatic GER (symptom scores) was low and comparable in both groups. Clinical success (ES <3) was sustained in all except 1 patient with recurrence (98.5%).
In a retrospective matched cohort, GER was significantly less frequent after POEM + F than only POEM, and wrap integrity was maintained in three-fourths of patients at the 3-year follow-up.
经口内镜下肌切开术（POEM）已被广泛用于治疗贲门失弛缓症。POEM术后胃食管反流（GER）已成为一个备受关注的问题。同期内镜下胃底折叠术（POEM + F）可能会减少POEM术后的GER。本研究比较了接受POEM与POEM + F治疗的贲门失弛缓症匹配队列患者在3年随访时的综合（客观和主观）GER结局。
这项单中心、回顾性、匹配队列研究比较了POEM + F与POEM。采用回顾性匹配，标准如下：年龄、性别、体重指数、贲门失弛缓症类型、既往干预措施以及美国麻醉医师协会分级。记录基线特征、术前/术后埃卡德特评分（ESs）、技术细节和不良事件。两组均每年随访3年。在3年时比较结局。主要结局是客观GER的发生率（里昂共识2.0）；次要结局是主观（有症状的）GER（GERD问卷、反流症状指数、GERD健康相关生活质量）以及临床成功率（ES <3）。P <.05被认为具有统计学意义。
34例接受POEM + F治疗的患者与34例接受POEM治疗的患者相匹配（POEM + F组连续纳入41例；排除7例[技术失败，2例；不适合匹配，5例]）。不良事件包括黏膜损伤（POEM组与POEM - F组分别为11.8%和8.8%；P =.69）。1例在9个月时复发（POEM + F组）被排除在长期随访之外。在3年随访时，15例接受POEM + F治疗的患者中有2例（13.3%）出现客观GER（食管酸暴露时间>6%和/或B级或更高等级食管炎），而12例接受POEM治疗的患者中有7例（58.3%）出现（P =.037）。3年时，76.5%的POEM + F病例胃底折叠术保持完整。有症状的GER（症状评分）较低，两组相当。除1例复发患者外，所有患者均维持临床成功（ES <3）（98.5%）。
在回顾性匹配队列中，POEM + F术后GER的发生率显著低于单纯POEM，并且在3年随访时四分之三的患者胃底折叠术保持完整。
