Peroral endoscopic myotomy (POEM) for esophageal achalasia
Peroral endoscopic myotomy (POEM) for esophageal achalasia
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DOI：
10.1055/s-0029-1244080
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发表时间：
2010-04-01
期刊：
影响因子：
9.3
通讯作者：
Kudo, S.
中科院分区：
文献类型：
--
作者：
Inoue, H.;Minami, H.;Kudo, S.
背景资料：经口内镜下肌切开术（POEM）是由我们的小组提供一个微创的永久治疗食管贲门失弛缓症Patients和方法：POEM进行了17例贲门失弛缓症（10名男性，7名女性，平均年龄41.4岁）。建立一个长的粘膜下隧道（平均长度12.4 cm），然后对平均总长度为8.1 cm（食管远端6.1 cm，贲门2.0 cm）的环形肌束进行内镜下肌切开术。顺利通过内窥镜通过胃食管交界处确认在结束的proceeding.Results：在所有情况下，POEM显著降低吞咽困难症状评分（从平均10至1.3; P = 0.0003）和静息下食管括约肌（LES）压力（从平均52.4毫米汞柱至19.9毫米汞柱; P = 0.0001）。未发生与POEM相关的严重并发症。随访期间（平均5个月），只有1例患者（病例17）发生反流性食管炎，需要额外治疗或药物治疗（洛杉矶分级B）;通过定期摄入蛋白泵抑制剂（PPIs）可以很好地控制这种情况。关于POEM的长期疗效以及与其他介入治疗的比较的进一步研究尚待进行。
Background: Peroral endoscopic myotomy (POEM) was developed by our group to provide a less invasive permanent treatment for esophageal achalasia.Patients and methods: POEM was performed in 17 consecutive patients with achalasia (10 men, 7 women; mean age 41.4 years). A long submucosal tunnel was created (mean length 12.4 cm), followed by endoscopic myotomy of circular muscle bundles of a mean total length of 8.1 cm (6.1 cm in distal esophagus and 2.0 cm in cardia). Smooth passage of an endoscope through the gastro-esophageal junction was confirmed at the end of the procedure.Results: In all cases POEM significantly reduced the dysphagia symptom score (from mean 10 to 1.3; P = 0.0003) and the resting lower esophageal sphincter (LES) pressure (from mean 52.4 mmHg to 19.9 mmHg; P = 0.0001). No serious complications related to POEM were encountered. During follow-up (mean 5 months), additional treatment or medication was necessary in only one patient (case 17) who developed reflux esophagitis (Los Angeles classification B); this was well controlled with regular intake of protein pump inhibitors (PPIs).Conclusions: The short-term outcome of POEM for achalasia was excellent; further studies on long-term efficacy and on comparison of POEM with other interventional therapies are awaited.