口周内镜下肌切开术治疗过度收缩食管(Jackhammer):长期随访的多中心回顾性系列研究。

IF 5.8 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
United European Gastroenterology Journal Pub Date : 2024-09-01 Epub Date: 2024-06-14 DOI:10.1002/ueg2.12586
David Albers, Mana Witt, John E Pandolfino, Thomas Rösch, Guido Schachschal, Torsten Beyna, Horst Neuhaus, Christian Gerges, Jennis Kandler, Hans-Dieter Allescher, Jan Martinek, Alessandro Repici, Alanna Ebigbo, Helmut Messmann, Brigitte Schumacher, Yuki B Werner
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引用次数: 0

摘要

简介:通过口周内窥镜肌切开术(POEM)治疗的非achalasia食管运动障碍作为一个独立的群体,其长期疗效数据十分有限。我们对有症状的食管过度收缩(杰克汉默食管)患者进行了研究:回顾性分析了 2012-2018 年在欧洲 7 个中心接受初级口周肌切开术治疗的 42 例症状性 Jackhammer 食管患者(平均年龄 60.9 岁;57% 为女性,平均 Eckardt 评分 6.2 ± 2.1);肌切开术包括食管下括约肌,但与治疗贲门失弛缓症的 POEM 相反,肌切开术延伸至贲门的部分不超过 1 厘米。测压数据由独立专家重新审查。主要结果是POEM术后至少两年后再治疗或Eckardt评分>3的失败率:结果:尽管技术成功率为 100%(平均干预时间 107 ± 48.9 分钟,平均肌切开长度 16.2 ± 3.7 厘米),但整个组的 2 年成功率为 64.3%。在一项亚组分析中,在 46.5 ± 19.0 个月的随访中,无食管胃交界流出道梗阻(EGJOO,n = 20)的 Jackhammer 患者(n = 22)和有食管胃交界流出道梗阻(EGJOO,n = 20)的患者(13.6% vs. 60%,p = 0.003)的 POEM 失败率有显著差异。9例患者(21.4%)发生了不良事件。14例(33.3%)患者接受了再治疗,其中两例患者由于反流而接受了手术胃底折叠术。在随访结束时,33 名患者(78.6%)的症状严重程度有所改善(Eckardt 评分≤3 分,平均 Eckardt 变化 4.34,p 结论:在随访结束时,33 名患者(78.6%)的症状严重程度有所改善(Eckardt 评分≤3 分,平均 Eckardt 变化 4.34,p 结论):有症状但无 EGJOO 的 Jackhammer 患者可在长期随访中受益于 POEM。但是,治疗有 EGJOO 的 Jackhammer 患者仍具有挑战性,可能需要进行全括约肌切开术,未来的研究应针对这种变异的发病机制和替代策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Peroral endoscopic myotomy for hypercontractile (Jackhammer) esophagus: A retrospective multicenter series with long-term follow-up.

Introduction: Long-term outcome data are limited for non-achalasia esophageal motility disorders treated by peroral endoscopy myotomy (POEM) as a separate group. We investigated a subset of symptomatic patients with hypercontractile esophagus (Jackhammer esophagus).

Methods: Forty two patients (mean age 60.9 years; 57% female, mean Eckardt score 6.2 ± 2.1) treated by primary peroral myotomy for symptomatic Jackhammer esophagus 2012-2018 in seven European centers were retrospectively analyzed; myotomy included the lower esophageal sphincter but did not extend more than 1 cm into the cardia in contrast to POEM for achalasia. Manometry data were re-reviewed by an independent expert. The main outcome was the failure rate defined by retreatment or an Eckardt score >3 after at least two years following POEM.

Results: Despite 100% technical success (mean intervention time 107 ± 48.9 min, mean myotomy length 16.2 ± 3.7 cm), the 2-year success rate was 64.3% in the entire group. In a subgroup analysis, POEM failure rates were significantly different between Jackhammer-patients without (n = 22), and with esophagogastric junction outflow obstruction (EGJOO, n = 20) (13.6% % vs. 60%, p = 0.003) at a follow-up of 46.5 ± 19.0 months. Adverse events occurred in nine cases (21.4%). 14 (33.3%) patients were retreated, two with surgical fundoplication due to reflux. Including retreatments, an improvement in symptom severity was found in 33 (78.6%) at the end of follow-up (Eckardt score ≤3, mean Eckardt change 4.34, p < 0.001). EGJOO (p = 0.01) and frequency of hypercontractile swallows (p = 0.02) were predictors of POEM failure. The development of a pseudodiverticulum was observed in four cases within the subgroup of EGJOO.

Conclusions: Patients with symptomatic Jackhammer without EGJOO benefit from POEM in long-term follow-up. Treatment of Jackhammer with EGJOO, however, remains challenging and probably requires full sphincter myotomy and future studies which should address the pathogenesis of this variant and alternative strategies.

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来源期刊
United European Gastroenterology Journal
United European Gastroenterology Journal GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
10.50
自引率
13.30%
发文量
147
期刊介绍: United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
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