Outcomes of per-oral endoscopic myotomy for treatment of esophageal achalasia with a median follow-up of 49 months
Outcomes of per-oral endoscopic myotomy for treatment of esophageal achalasia with a median follow-up of 49 months
复制标题
经口内镜肌切开术治疗食管贲门失弛缓症的结果，中位随访时间为 49 个月
DOI：
10.1016/j.gie.2017.10.031
复制
发表时间：
2018-06-01
影响因子：
7.7
通讯作者：
Zhou, Ping-Hong
中科院分区：
文献类型：
--
作者：
Li, Quan-Lin;Wu, Qiu-Ning;Zhou, Ping-Hong
背景和目的：经口内窥镜肌切开术（POEM）作为食管贲门失弛缓症的高效且安全的治疗方法已被广泛接受。短期、小规模研究较多，但长期、大规模研究较少。本研究的目的是系统分析 POEM 的长期结果，特别强调 POEM 失败和相关风险因素。方法：在这项单中心研究中，纳入了 2010 年 8 月至 2012 年 12 月期间连续接受 POEM 治疗的患者。 Kaplan-Meier 生存函数用于估计每年的临床成功率。采用Cox比例风险模型分析复发相关危险因素。结果：共纳入564例患者。 36 名患者（6.4%）发生了主要围手术期不良事件。中位随访 49 个月（范围 3-68）后，Eckardt 评分和下食管括约肌 (LES) 压力显着下降（中位 Eckardt 评分为 8 至 2 [P < .05]；中位 LES 压力为 29.7 mm Hg 至 11.9 mm Hg [P < .05]）。 3 个月内发生 15 起故障，3 个月至 3 年内发生 23 起，3 年后发生 10 起。 1年、2年、3年、4年和5年的估计临床成功率分别为94.2%、92.2%、91.1%、88.6%和87.1%。多变量 Cox 回归显示，病程长（>= 10 年）和既往干预史是复发的危险因素。 37.3% 的患者 (155/ 416) 发生临床反流。结论：POEM 是一种高度安全有效的食管贲门失弛缓症治疗方法，具有良好的长期预后。
Background and Aims: Per-oral endoscopic myotomy (POEM) has received wide acceptance as a highly effective and safe treatment for esophageal achalasia. Short-term and small-scale studies are ample, but long-term large-scale studies are few. The aim of the study was to systematically analyze our long-term results of POEM, with particular emphasis on POEM failures and associated risk factors.Methods: In this single-center study, consecutive patients treated with POEM between August 2010 and December 2012 were included. The Kaplan-Meier survival function was used to estimate clinical success rate at each year. The Cox proportional hazards model was used to analyze risk factors related to recurrence.Results: A total of 564 patients were included. Major perioperative adverse events occurred in 36 patients (6.4%). After a median follow-up of 49 months (range, 3-68), the Eckardt score and lower esophageal sphincter (LES) pressure were significantly decreased (median Eckardt score, 8 to 2 [P < .05]; median LES pressure, 29.7 mm Hg to 11.9 mm Hg [P < .05]). Fifteen failures occurred within 3 months, 23 between 3 months and 3 years, and 10 after 3 years. The estimated clinical success rates at 1, 2, 3, 4, and 5 years were 94.2%, 92.2%, 91.1%, 88.6%, and 87.1%, respectively. Multivariate Cox regression revealed long disease duration (>= 10 years) and history of prior interventions to be risk factors for recurrence. Clinical reflux occurred in 37.3% of patients (155/ 416).Conclusions: POEM is a highly safe and effective treatment for esophageal achalasia with favorable long-term outcomes.