Repeat peroral endoscopic myotomy: a salvage option for persistent/recurrent symptoms
Repeat peroral endoscopic myotomy: a salvage option for persistent/recurrent symptoms
复制标题
重复经口内窥镜肌切开术：针对持续性/复发性症状的挽救选择
DOI：
10.1055/s-0034-1393095
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发表时间：
2016-02-01
期刊：
影响因子：
9.3
通讯作者：
Zhou, Ping-Hong
中科院分区：
文献类型：
--
作者：
Li, Quan-Lin;Yao, Li-Qing;Zhou, Ping-Hong
背景和研究目的：虽然经口内镜肌切开术（POEM）被认为在治疗贲门失弛缓症中具有较高的成功率，但术后偶尔可能会出现持续/复发症状。我们的目的是评估重复经口内镜肌切开术（Re-POEM）作为初次POEM失败后挽救治疗的可行性、安全性和有效性。患者和方法：从前瞻性维护的数据库中回顾性选择了15例既往POEM后症状持续/复发的患者（Eckardt症状评分≥ 4），该数据库共包含1454例贲门失弛缓症连续患者。 主要终点是随访期间的症状缓解，定义为Eckardt评分≤ 3。次要结局指标是手术相关不良事件、测压下食管括约肌（LES）压力变化和Re-POEM前后的反流症状。 结果：所有患者在初次POEM手术后平均13.5个月（范围4 - 37个月）成功接受了Re-POEM。 平均手术时间为41.5分钟（范围28 - 62分钟）。 1例粘膜下隧道感染经保守治疗成功治愈。在平均11.3个月（范围3 - 18个月）的随访期间，所有患者均获得了治疗成功。 治疗前的平均症状评分为5.6（范围4-8），而治疗后平均为1.2（范围0-3; P <0.001）。 平均LES压力在Re-POEM后也从25.0mmHg降至9.5 mmHg（P <0.001）。 Re-POEM的总体临床反流并发症发生率为33.3%。 结论：在初始POEM失败后，Re-POEM作为补救选择似乎是安全有效的，可在短期内缓解症状，并且所有患者均无严重并发症。
Background and study aims: Although peroral endoscopic myotomy (POEM) is credited with high success rates in the treatment of achalasia, persistent/recurrent symptoms may occasionally develop afterwards. Our purpose was to evaluate the feasibility, safety, and efficacy of repeat peroral endoscopic myotomy (Re-POEM) as salvage therapy after initial POEM failure. Patients and methods: Fifteen patients with persistence/recurrence of symptoms after previous POEM (Eckardt symptom score ≥ 4) were retrospectively selected from a prospectively maintained database housing a total of 1454 consecutive patients with achalasia. The primary endpoint was symptom relief during follow-up, defined by an Eckardt score of ≤ 3. Secondary outcome measures were procedure-related adverse events, change in manometric lower esophageal sphincter (LES) pressure, and reflux symptoms before and after Re-POEM. Results: All patients underwent successful Re-POEM a mean of 13.5 months (range 4 – 37 months) after execution of their primary POEM procedures. Mean operative time was 41.5 minutes (range 28 – 62 minutes). One instance of submucosal tunnel infection was successfully managed with conservative treatment. During a mean follow-up period of 11.3 months (range 3 – 18 months), therapeutic success was achieved in all patients. The mean symptom score pretreatment was 5.6 (range 4 – 8), compared with a post-treatment mean of 1.2 (range 0 – 3; P < 0.001). Mean LES pressure also declined from 25.0 mmHg to 9.5 mmHg after Re-POEM (P < 0.001). The overall clinical reflux complication rate of Re-POEM was 33.3 %. Conclusions: Re-POEM appears safe and effective as a salvage option after initial POEM failure, conferring short-term symptom relief and being free of serious complications in all patients.