在食道中的POEM - 如何处理POEM后的反流
Martin Ďuriček1, Michal Demeter1, Peter Bánovčin1
1Clinic of Internal Medicine - Gastroenterology, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovakia.
Best practice & research. Clinical gastroenterology
|August 29, 2024
概括
胃食道逆流是口腔内镜肌切除术 (POEM) 后的一个重大问题,比其他阿喀拉西亚治疗更频繁. 虽然质子抑制剂有帮助,但对于耐火病例需要进一步调查食道过敏和停滞.
科学领域:
- 胃肠病学 胃肠病学
- 内镜检查是指内镜检查.
- 消化系统生理学 消化系统生理学
背景情况:
- 在口腔内镜肌切除术 (POEM) 后,逆流是主要关注的问题.
- 确定POEM后反流的确切发病率是具有挑战性的,因为症状,食道炎和酸暴露之间的相关性很差.
- 在POEM后的反流发病率似乎高于赫勒肌切除术或气动扩张.
研究的目的:
- 调查POEM后反流的发生率和管理.
- 探索耐火性反流和长期并发症的潜在原因.
- 评估新的诊断和程序修改,以减少POEM后反流.
主要方法:
- 评估POEM后反流的诊断挑战的审查.
- 对质子抑制剂 (PPI) 疗效和限制的分析.
- 讨论潜在的原因,包括食道过敏和停滞,通过pH测量诊断.
- 检查长期并发症,如狭窄和巴雷特食道.
- 评估程序修改和新的诊断工具,如内膜功能光成像探针.
主要成果:
- 在POEM后的反流比使用替代疗法更常见.
- 质子抑制剂对许多人有效,但存在耐火病例.
- 食道过敏和停滞可能是耐火性反流的原因.
- 长期并发症很少见,但包括胃狭窄和巴雷特食道.
- 目前的程序修改没有产生减少反流的首选技术.
结论:
- 反流是POEM的重要并发症,与其他阿喀拉西亚治疗相比,发病率更高.
- 难治性反流可能源于食道过敏或停滞,需要先进的诊断.
- 个性化肌肉切除术使用诸如内膜功能光成像探针之类的工具,可以减少反流发病率.
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