治疗乙状结肠型贲门失弛缓症的短食管肌切开术与标准肌切开术：一项国际多中心研究的结果。

IF 6.7 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastrointestinal endoscopy Pub Date : 2025-02-01 DOI:10.1016/j.gie.2024.08.025

Eric Swei MD, MS , Zachary Kassir MD , Apurva Pravin Shrigiriwar MBBS , Alex Schlacterman MD , Chen-Shuan Chung MD , Francesco Vito Mandarino MD , Prashant Kedia MD , Helmut Messman MD , Rishi Pawa MBBS , Pankaj Desai MD , Payal Saxena MD , Redeat Assefa MD, MSc, MPH , Martha Arevalo-Mora MD , Francesco Azzolini MD , Paulo Giorgio Arcidiacono MD , Sandra Nagl MD , Mohamad-Noor Abu-Hammour MD , Miguel Puga-Tejada MD, MSc , Jorge Baquerizo-Burgos MD , Maria Egas-Izquierdo MD , Mouen Khashab MD

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引用次数: 0

摘要

背景和目的：乙状结肠型贲门失弛缓症患者采用经口内镜下肌切开术（POEM）治疗具有挑战性。短肌切开术可提高技术成功率，但之前尚未对结果进行评估方法：这是一项多中心、国际性、回顾性研究，研究对象为接受过短（≤ 4 厘米）或标准食管肌切开术（POEM）的患者。结果包括临床和技术成功率、手术不良事件和反流率：共有109名乙状结肠贲门失弛缓症患者（乙状结肠贲门失弛缓症=74人，晚期乙状结肠贲门失弛缓症=35人）在13个中心接受了POEM手术（短食管肌切术=59人，标准食管肌切术=50人）。两组患者的技术成功率均为 100%。接受短肌切开术的患者平均手术时间明显更短（57.7 ± 27.8 分钟 vs 83.1 ± 44.7 分钟，p = 0.0005）。6名患者（5.5%；4名轻度，2名中度）共发生了6次AE；AE发生率在短肌切术组和标准肌切术组之间无明显差异。98名患者获得了随访数据（中位数=3.6个月[IQR，1-14]）。临床成功率为 94%（短效组 = 93%；标准组 = 95%，P = 0.70），且无贲门失弛缓症亚型或乙状结肠贲门失弛缓症严重程度的差异。21名患者（22%）报告了POEM术后反流，44%的患者（16/36）有病理反流的客观证据。标准组与短肌切术组相比，病理反流率明显增加（OR 18.0 [95% CI: 2.0 - 159.0]; p = 0.009）：结论：POEM短肌切开术对乙状结肠和晚期乙状结肠贲门失弛缓症的短期治疗有效且安全。与标准肌切开术相比，短肌切开术可能导致较少的反流。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Short esophageal myotomy versus standard myotomy for treatment of sigmoid-type achalasia: results of an international multicenter study

Background and Aims

Patients with sigmoid-type achalasia can be challenging to treat with peroral endoscopic myotomy (POEM). A short myotomy improves technical success; however, outcomes have not previously been evaluated.

Methods

This was a multicenter, international, retrospective study of patients who underwent POEM with short (≤4 cm) or standard esophageal myotomy. Outcomes included clinical and technical success, procedural adverse events, and reflux rates.

Results

A total of 109 patients with sigmoid achalasia (sigmoid, n = 74; advanced sigmoid, n = 35) underwent POEM across 13 centers (short myotomy, n = 59; standard, n = 50). Technical success was 100% across both groups. Patients who underwent short myotomy had a significantly shorter mean procedure time (57.7 ± 27.8 vs 83.1 ± 44.7 minutes, P = .0005). A total of 6 adverse events were recorded in 6 patients (5.5%; 4 mild, 2 moderate); the adverse event rate was not significantly different between short and standard groups. Ninety-eight patients had follow-up data (median, 3.6 months; interquartile range, 1-14 months). Clinical success was 94% (short, 93%; standard, 95%; P = .70) and did not differ based on achalasia subtype or sigmoid achalasia severity. Twenty-one (22%) patients reported post-POEM reflux and 44% (16 of 36) had objective evidence of pathologic reflux. Rates of pathologic reflux were significantly increased in the standard versus short group (odds ratio, 18.0; 95% confidence interval, 2.0-159.0; P = .009).

Conclusions

POEM with short myotomy is effective and safe for the short-term treatment of sigmoid and advanced sigmoid achalasia. Short myotomy may lead to less reflux than standard myotomy.

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来源期刊

Gastrointestinal endoscopy 医学-胃肠肝病学

CiteScore

10.30

自引率

7.80%

发文量

1441

审稿时长

38 days

期刊介绍： Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.