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引用次数: 0
摘要
口腔内镜下肌切开术(POEM)术后反流可以说是该手术最令人担忧的问题之一。由于反流症状、食管炎和异常酸暴露的相关性很差,因此很难确定确切的发生率,需要进行彻底的诊断调查。不过,在所有这三个参数方面,其发生率都高于海勒肌切开术或气压扩张术后。虽然 PPI 能有效缓解症状并治愈食管炎,但仍有难治性患者存在。食管过敏和酸性发酵/食管淤积是最可能的原因,可通过手动分析 pH 值测定跟踪来诊断。消化性狭窄和巴雷特食管等长期并发症很少见,仅有零星报道。为了减少 POEM 术后反流,对 POEM 手术进行了修改,但并没有找到最终的首选技术。内腔功能成像探头等现代检查方法可能有助于根据下食管括约肌的理想扩张性进行个性化的肌切开术,减少反流。
POEM in the esophagus - How to deal with the post-POEM reflux
Reflux after peroral endoscopic myotomy (POEM) is arguably one of the greatest concerns related to the procedure. The exact incidence is difficult to establish as reflux symptoms, esophagitis, and abnormal acid exposure correlate poorly, warranting thorough diagnostic investigation. The incidence is, however, higher than after Heller myotomy or pneumatic dilatation across all these three parameters. Although PPI are effective in the resolution of symptoms and healing of esophagitis, refractory patients exist. Esophageal hypersensitivity and acidic fermentation/esophageal stasis are most likely causes and could be diagnosed by manual analysis of pH metry tracings. Long-term complications like peptic stricture and Barrett's esophagus are rare and reported sporadically. Modifications of POEM procedure aiming to decrease post-POEM reflux led to no conclusive preferred technique. Modern investigations like endoluminal functional lumen imaging probe might help to personalize myotomy to the desired distensibility of the lower esophageal sphincter and decrease reflux.
期刊介绍:
Each topic-based issue of Best Practice & Research Clinical Gastroenterology will provide a comprehensive review of current clinical practice and thinking within the specialty of gastroenterology.