Effects of peroral endoscopic myotomy on esophageal motility in patients with achalasia

中华消化内镜杂志 Pub Date : 2020-02-20 DOI:10.3760/CMA.J.ISSN.1007-5232.2020.02.008

Si-Kai Liu, F. Meng

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Abstract

Objective To evaluate the effects of peroral endoscopic myotomy (POEM) on esophageal motility in patients with achalasia(AC) after POEM. Methods Demographics, clinical and manometric data, and outcomes were collected from the medical records of patients who received POEM as the primary therapy for AC in Beijing Friendship Hospital from January 2012 to June 2016. The rate of treatment success and change in esophageal dynamics before and after treatment were compared in different types of AC. Results At 6 months′ follow-up of POEM, the symptom remission rate of AC patients with type Ⅰ, type Ⅱ, and type Ⅲ was 100.0% (13/13), 95.5% (42/44) and 90.1% (10/11), respectively. Within 6 months after POEM, lower esophageal sphincter resting pressure [10.5 (6.9, 15.8) mmHg VS 24.6 (18.3, 35.1) mmHg, 1 mmHg=0.133 kPa], 4 s integrated relaxation pressure [6.0 (3.7, 8.8) mmHg VS 21.8 (15.3, 28.0) mmHg], upper esophageal sphincter (UES)resting pressure [43.4 (33.7, 57.3) mmHg VS 45.3 (33.2, 71.1) mmHg] and UES residual pressure [1.5 (0.0, 4.6) mmHg VS 3.9 (1.1, 6.9) mmHg] were significantly improved compared with those of pre-operation (all P<0.05). At 6 months after POEM, esophageal dilatation diameter (3.0±0.7 cm VS 3.9±1.1 cm) and Eckardt scores [1 (0, 2) VS 6 (5, 8)] were also significantly improved compared with those of pre-operation (all P<0.001). After POEM, the esophageal body peristalsis did not recover in type Ⅰ AC patients. Four patients (9.1%, 4/44) of type Ⅱ AC recovered weak peristalsis or premature contraction, and 10 patients (90.9%, 10/11) of type Ⅲ AC recovered with more normal peristaltic wave, and the rate of pre-systolic contraction or weak peristalsis increased. Conclusion POEM can improve the esophagogastric junction outflow tract obstruction and change the esophageal body motility.After POEM, part patients have recovery of esophageal body motility, which is most obvious in type Ⅲ AC, followed by type Ⅱ, and type Ⅰ AC patients have no significant change. Key words: Esophageal achalasia; Peroral endoscopic myotomy; Esophageal motility

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经口内镜下肌切开术对贲门失弛缓症患者食管运动的影响

目的评价经口内镜肌切开术（POEM）对贲门失弛缓症（AC）患者术后食管动力的影响。方法从2012年1月至2016年6月在北京友谊医院接受POEM作为AC初级治疗的患者的病历中收集人口学、临床和测压数据以及结果。比较不同类型AC的治疗成功率和治疗前后食管动力学的变化。结果POEM随访6个月，Ⅰ型、Ⅱ型和Ⅲ型AC患者的症状缓解率分别为100.0%（13/13）、95.5%（42/44）和90.1%（10/11）。POEM后6个月内，食管下括约肌静息压[10.5（6.9，15.8）mmHg VS 24.6（18.3，35.1）mmHg，1mmHg=0.133kPa]，4 s综合舒张压[6.0（3.7，8.8）mmHg VS 21.8（15.3，28.0）mmHg]，上食管括约肌（UES）静息压[43.4（33.7,57.3）mmHg VS 45.3（33.2,71.1）mmHg]和UES残余压[1.5（0.0,4.6）mmHg VS3.9（1.1,6.9）mmH]与术前相比均有显著改善（均P<0.05），食管扩张直径（3.0±0.7cm VS 3.9±1.1cm）和Eckardt评分[1（0，2）VS 6（5，8）]均较术前有显著改善（均P＜0.001）。4例（9.1%，4/44）Ⅱ型AC患者恢复了弱蠕动或早期收缩，10例（90.9%，10/11）Ⅲ型AC患者以更正常的蠕动波恢复，收缩前收缩或弱蠕动率增加。结论POEM可改善食管胃交界处流出道梗阻，改变食管体运动。POEM后，部分患者食管体动力恢复，以Ⅲ型AC最为明显，其次为Ⅱ型，Ⅰ型AC患者无明显变化。关键词：食管贲门失弛缓症；经口内镜肌切开术；食管运动

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来源期刊

中华消化内镜杂志

CiteScore

0.10

自引率

0.00%

发文量

7555

期刊介绍： Chinese Journal of Digestive Endoscopy is a high-level medical academic journal specializing in digestive endoscopy, which was renamed Chinese Journal of Digestive Endoscopy in August 1996 from Endoscopy. Chinese Journal of Digestive Endoscopy mainly reports the leading scientific research results of esophagoscopy, gastroscopy, duodenoscopy, choledochoscopy, laparoscopy, colorectoscopy, small enteroscopy, sigmoidoscopy, etc. and the progress of their equipments and technologies at home and abroad, as well as the clinical diagnosis and treatment experience. The main columns are: treatises, abstracts of treatises, clinical reports, technical exchanges, special case reports and endoscopic complications. The target readers are digestive system diseases and digestive endoscopy workers who are engaged in medical treatment, teaching and scientific research. Chinese Journal of Digestive Endoscopy has been indexed by ISTIC, PKU, CSAD, WPRIM.