超收缩性 (杰克汉默) 食道的口腔内镜肌切除术:一个回顾性多中心系列,长期随访
David Albers1, Mana Witt2, John E Pandolfino3
1Department of Internal Medicine and Gastroenterology, Elisabeth-Krankenhaus Essen, Essen, Germany.
United European gastroenterology journal
|June 14, 2024
概括
口腔内镜肌切除术 (POEM) 显示,Jackhammer食道的成功率为64.3%,但当食道胃结出流阻塞 (EGJOO) 存在时,结果显著不同. 没有EGJOO的患者长期受益,而有EGJOO的患者面临挑战,表明需要替代策略.
科学领域:
- 胃肠病学和内镜检查
- 食道运动障碍 食道运动障碍
- 最少侵入性的手术
背景情况:
- 有限的长期结果数据存在于非秋拉西亚食道运动障碍的口腔内镜肌切除术 (POEM).
- 超收缩性食道,也称为杰克食道,是一种症状性运动障碍.
- 研究POEM在Jackhammer食道中的疗效对于了解治疗结果至关重要.
研究的目的:
- 为了评估口腔内镜肌切除术 (POEM) 的长期结果,在患有症状的杰克食道的患者中.
- 在这个患者队列中确定影响POEM成功率的因素.
- 为了比较Jackhammer食道患者与没有食道胃节外流阻塞 (EGJOO) 之间的结果.
主要方法:
- 在2012年至2018年期间,在七个欧洲中心对42名患有症状的杰克食道患者进行了回顾性分析,这些患者接受了初级POEM治疗.
- 肌切除术的目标是食道下部关节,但没有显著地延伸到心脏.
- 失败被定义为重新治疗或至少两年后的埃卡德得分>3; manometry 数据被独立重新审查.
主要成果:
- 在Jackhammer食道中,POEM的整体两年成功率为64.3%,尽管技术成功率为100%.
- 与没有 (13.6%) (p=0.003) 相比,EGJOO患者 (60%) 的POEM失败率显著更高.
- EGJOO和高频率的超收缩吞是POEM失败的预测因素; 78.6%的患者在随访后症状有所改善.
结论:
- 口腔内镜肌切除术 (POEM) 对没有EGJOO的有症状的杰克汉默食道患者提供长期益处.
- 治疗Jackhammer食道与同时存在的EGJOO仍然具有挑战性,可能需要修改肌肉切割技术或替代策略.
- 需要进一步的研究来阐明EGJOO在Jackhammer食道中的病变性,并探索新的治疗方法.
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