Boutros Christina S, Boutros Catherine A, Benson Jamie R, Khan Saher-Zahra, Simon Emily, Wieland Patrick, Chatha Hamza Nasir, Lyons Joshua, Marks Jeffrey M
Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH, USA.
Department of Surgery, Case Western Reserve University, Cleveland, OH, USA.
Surg Endosc. 2025 Jul 23. doi: 10.1007/s00464-025-11947-3.
Peroral Endoscopic Myotomy (POEM) is a minimally invasive and effective treatment for esophageal motility disorders like achalasia. While POEM achieves high success rates, the influence of esophageal morphology on post-operative outcomes remains unclear. Existing studies focus on symptom resolution and manometric changes, but limited data assess whether features such as esophageal diameter, and angulation impact treatment failure or the need for additional interventions.
We retrospectively analyzed achalasia patients who underwent POEM at a single institution (2012-2024). Patients were grouped by esophageal morphology from preoperative timed barium swallow: esophageal diameter (< 3 cm, 3-5 cm, > 5 cm), and angulation, and bird's beak appearance. POEM failure was defined as the need for repeat intervention, symptom recurrence, or post-operative Eckardt score > 3. Multivariable logistic regression assessed associations between morphology and outcomes.
Among 88 patients, esophageal diameter > 5 cm was more frequently associated with bird's beak appearance (71% vs. 65% vs. 31%, p < 0.05). Bird's beak appearance was linked to higher post-operative IRP (44.0 mmHg vs. 12.8 mmHg, p = 0.03) but not to symptom recurrence. Increased esophageal angle was significantly associated with post-operative endoscopic intervention (140.3° vs. 127.8°, p = 0.02), though diameter and bird's beak appearance were not predictive POEM outcomes.
Esophageal morphology does not significantly impact symptom recurrence or the need for repeat interventions post-POEM. However, an increased esophageal angle may predict the need for post-operative endoscopic intervention. These findings suggest that esophageal morphology should not be considered a contraindication to POEM.
经口内镜下肌切开术（POEM）是治疗贲门失弛缓症等食管动力障碍的一种微创且有效的方法。虽然POEM成功率较高，但食管形态对术后结果的影响仍不明确。现有研究主要关注症状缓解和测压变化，但评估食管直径和角度等特征是否会影响治疗失败或是否需要额外干预的数据有限。
我们回顾性分析了在单一机构（2012 - 2024年）接受POEM治疗的贲门失弛缓症患者。根据术前定时钡餐检查的食管形态对患者进行分组：食管直径（<3cm、3 - 5cm、>5cm）、角度以及鸟嘴样外观。POEM失败定义为需要重复干预、症状复发或术后埃卡德特评分>3。多变量逻辑回归评估形态与结果之间的关联。
在88例患者中，食管直径>5cm与鸟嘴样外观的关联更为频繁（71%对65%对31%，p<0.05）。鸟嘴样外观与术后较高的下食管括约肌压力（44.0mmHg对12.8mmHg，p = 0.03）相关，但与症状复发无关。食管角度增加与术后内镜干预显著相关（140.3°对127.8°，p = 0.02），尽管直径和鸟嘴样外观并不能预测POEM的结果。
食管形态对POEM术后症状复发或重复干预的需求没有显著影响。然而，食管角度增加可能预测术后内镜干预的需求。这些发现表明食管形态不应被视为POEM的禁忌证。
