New endoscopic classification of esophageal mucosa in achalasia: A predictor for submucosal fibrosis.
New endoscopic classification of esophageal mucosa in achalasia: A predictor for submucosal fibrosis.
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DOI：
10.4103/sjg.sjg_459_17
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发表时间：
2018-03
期刊：
影响因子：
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通讯作者：
Ding H
中科院分区：
文献类型：
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作者：
Feng X;Linghu E;Chai N;Ding H
在这项研究中，我们旨在探讨一种新的食道黏膜分类方法对黏膜下纤维化(SMF)的预测能力，以影响经口腔内窥镜下肌切开术(POEM)的成功。对2012-2016年间施行POPE的贲门失弛缓症患者的内窥镜和临床资料进行回顾性分析。根据内窥镜图像或视频记录血症分级和SMF分级。用Spearman等级相关分析评价血症与SMF分级的关系，用Logistic回归分析确定SMF的预测因素。共有568名接受POPE的贲门失弛缓症患者入选。血症分级：a级40例(7.0%)，b级373例(65.7%)，f4级139例(24.5%)，a级14例(2.5%)，c级1例(0.2%)，d级1例(0.2%)，f4级1例(0.2%)。POEM手术流产16例，其中93.8%(15/16)是由于严重的SMF。由于e级和f级很少见，相关的SMF明显，这两个分级病例被排除在以下分析之外。血症与SMF分级显著相关(Spearman r=0.62，P<；0.01)。多因素Logistic回归分析显示，年龄、性别、病程、LING分级、既往治疗和血症分级是晚期SMF的独立预测因素(优势比=26.547，95%可信区间：15.809~44.578，P<；0.01)。新的内窥镜血症分类是POEM期间晚期SMF的独立预测因子。这种分类可以用来评价诗歌的难度和成败。
In this study, we aim to investigate the predicting ability of one new endoscopic classification of esophageal mucosa in achalasia (EMIA) for submucosal fibrosis (SMF) affecting the success of peroral endoscopic myotomy (POEM). The endoscopic and clinical data of achalasia patients undergoing POEM from 2012 to 2016 were investigated retrospectively. According to the endoscopic images or videos, EMIA and SMF grades were recorded. The relation between EMIA and SMF gradings was assessed by Spearman's rank correlation, and the predictive factors of SMF were identified by logistic regression analysis. A total of 568 achalasia patients who underwent POEM were enrolled. For EMIA classification, there were 40 (7.0%), 373 (65.7%), 139 (24.5%), 14 (2.5%), 1 (0.2%), and 1 (0.2%) case (s) for grades a, b, c, d, e1, and f4, respectively. POEM procedures were aborted in 16 patients, and 93.8% (15/16) were due to severe SMF. Because grades e and f were rare and the related SMF was obvious, these two grading cases were excluded from the following analysis. Correlation between EMIA and SMF gradings was significant (Spearman r = 0.62, P < 0.01). Multivariate logistic analysis, including age, sex, disease duration, Ling classification, previous treatment, and EMIA classification, demonstrated that the EMIA classification (grades c to d) was an independent predictor for advanced SMF (odds ratio = 26.547, 95% confidence interval: 15.809–44.578, P < 0.01). The new endoscopic EMIA classification is an independent predictor of advanced SMF during POEM. The classification may be used for assessment of the difficulty and success of POEM.