Per-oral endoscopic myotomy white paper summary
Per-oral endoscopic myotomy white paper summary
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DOI：
10.1016/j.gie.2014.04.014
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发表时间：
2014-07-01
影响因子：
7.7
通讯作者：
Vassiliou, Melina C.
中科院分区：
文献类型：
--
作者：
Stavropoulos, Stavros N.;Desilets, David J.;Vassiliou, Melina C.
贲门失弛缓症是一种罕见的食道运动障碍，在这种疾病中，抑制性神经元的选择性丧失导致蠕动丧失和下食道括约肌（LES）对食物丸的反应不能充分松弛。目前还没有能够逆转失弛缓症病理生理的治疗方法。治疗方案旨在改善固体和液体通过胃食管交界处（GEJ）的通道。传统的治疗方法包括手术肌切开术和内窥镜破坏或削弱LES的方法，如内窥镜球囊扩张和肉毒杆菌毒素注射（BI）。经口内窥镜肌切开术（POEM）代表了一种自然口腔内窥镜手术（NOTES）方法来进行Heller肌切开术。初步数据表明，这种微创内窥镜手术可以达到与外科肌切开术相似的临床效果。作为2012年7月在芝加哥举行的年度自然口外科评估与研究联盟（NOSCAR）会议的一部分，组织了一次会议，共同审查POEM并就POEM的现状制定共识文件。国际诗歌调查（IPOEMS）是由会议主持人设计和实施的，作为NOSCAR倡议的一部分，试图用诗歌早期采用者的当前数据来补充稀少的已发表文献。该调查现已详细公布1，包括5个亚洲、7个北美和4个欧洲专家中心，在2012年7月调查时，他们总共有841例POEM手术的经验，包括所有高容量中心（每个中心约30例）。这些数据涵盖了POEM的各个方面，并提供给NOSCAR POEM小组演讲者，以帮助他们准备小组演讲，作为本白皮书的基础。
Achalasia is an uncommon esophageal motility disorder in which there is selective loss of inhibitory neurons resulting in loss of peristalsis and failure of adequate relaxation of the lower esophageal sphincter (LES) in response to food bolus. There is no current curative treatment that reverses the pathophysiology of achalasia. The treatment options are aimed at improving the passage of solids and liquids through the gastroesophageal junction (GEJ). The traditional treatment options include surgical myotomy and endoscopic methods that disrupt or weaken the LES, such as endoscopic balloon dilation and botulinum toxin injection (BI).Per-oral endoscopic myotomy (POEM) represents a natural orifice transluminal endoscopic surgery (NOTES) approach to Heller myotomy. Preliminary data suggest that this minimally invasive endoscopic procedure may achieve clinical results similar to those of surgical myotomy. As part of the annual Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) meeting held in Chicago in July 2012, a conference was organized to collaboratively review POEM and develop a consensus document on the current status of POEM. An International POEM Survey (IPOEMS) was designed and conducted by the session moderators as part of this NOSCAR initiative to attempt to supplement the scant published literature with current data from POEM early adopters. The survey, which has now been published in detail, 1 included 5 Asian, 7 North American, and 4 European expert centers with a combined experience of 841 POEM procedures, including all high-volume centers (>30 cases per center) at the time of the survey in July 2012. These data span every aspect of POEM and were made available to the NOSCAR POEM panel presenters to assist them with preparation of their panel presentations that served as the basis of this white paper.