Kaizuka Masatoshi, Tatsuta Tetsuya, Sawada Yohei, Asari Taka, Hayamizu Shiro, Oota Shinji, Hasui Keisuke, Kikuchi Hidezumi, Hiraga Hiroto, Chinda Daisuke, Mikami Tatsuya, Fukuda Shinsaku, Sakuraba Hirotake
Department of Gastroenterology Hematology and Clinical Immunology Hirosaki University Graduate School of Medicine Aomori Japan.
Department of Community Medicine Hirosaki University Graduate School of Medicine Aomori Japan.
DEN Open. 2025 Sep 3;6(1):e70196. doi: 10.1002/deo2.70196. eCollection 2026 Apr.
Peroral endoscopic myotomy (POEM) is an established treatment for esophageal achalasia. Despite favorable outcomes, the risk of reflux aspiration during general anesthesia induction in POEM remains a concern. This study aimed to identify the risk factors for food residue in the esophagus before POEM and evaluate the necessity of esophagogastroduodenoscopy (EGD) and cleansing the day before POEM.
A retrospective analysis of 61 patients with esophageal achalasia and esophagogastric junction outflow obstruction undergoing POEM between July 2017 and March 2024 was performed. Patients were divided into two groups based on the presence of food residue observed during preoperative EGD: residual ( = 16) and no-residual ( = 45) food groups. The factors compared included age, sex, Chicago criteria, duration of symptoms, Eckardt score, integrated relaxation pressure, esophageal dilation grade and type on esophagography, and presence of residual food during the initial EGD.
In univariate analysis, residual food was more common in patients aged <60 years ( < 0.05) and those with higher esophageal dilation grades ( < 0.05). Additionally, residual food during the initial EGD was identified as a significant predictor ( < 0.05).
Preoperative EGD and esophageal cleansing the day before POEM may be warranted in patients with initial EGD-detected residue, younger age, and marked dilation, to reduce reflux aspiration risk and improve procedural safety.
经口内镜下肌切开术（POEM）是治疗食管贲门失弛缓症的一种既定疗法。尽管疗效良好，但POEM手术中全身麻醉诱导期间反流误吸的风险仍是一个关注点。本研究旨在确定POEM术前食管内食物残渣的危险因素，并评估术前进行食管胃十二指肠镜检查（EGD）和清洁的必要性。
对2017年7月至2024年3月期间接受POEM治疗的61例食管贲门失弛缓症和食管胃交界部流出道梗阻患者进行回顾性分析。根据术前EGD观察到的食物残渣情况将患者分为两组：有残渣组（n = 16）和无残渣组（n = 45）。比较的因素包括年龄、性别、芝加哥标准、症状持续时间、埃卡特评分、综合松弛压、食管造影的食管扩张分级和类型，以及初次EGD时有无食物残渣。
单因素分析显示，食物残渣在年龄<60岁的患者中更常见（P < 0.05），在食管扩张分级较高的患者中也更常见（P < 0.05）。此外，初次EGD时存在食物残渣被确定为一个显著的预测因素（P < 0.05）。
对于初次EGD检查发现有残渣、年龄较小且扩张明显的患者，术前进行EGD检查和POEM前一天清洁食管可能是必要的，以降低反流误吸风险并提高手术安全性。
