Abstract

Introduction

Many centers have reported excellent short-term efficacy of per-oral endoscopic myotomy (POEM) for the treatment of achalasia. However, long-term data are limited and there are few studies comparing the efficacy of POEM versus Heller Myotomy (HM).

Aims

To compare the long-term clinical efficacy of POEM versus HM.

Methods

Using a retrospective, parallel cohort design, all cases of POEM or HM for achalasia between 2010 and 2015 were assessed. Clinical failure was defined as (a) Eckardt Score > 3 for at least 4 weeks, (b) achalasia-related hospitalization, or (c) repeat intervention. All index manometries were classified via Chicago Classification v3. Pre-procedural clinical, manometric, radiographic data, and procedural data were reviewed.

Results

98 patients were identified (55 POEM, 43 Heller) with mean follow-up of 3.94 years, and 5.44 years, respectively. 83.7% of HM patients underwent associated anti-reflux wrap (Toupet or Dor). Baseline clinical, demographic, radiographic, and manometric data were similar between the groups. There was no statistical difference in overall long-term success (POEM 72.7%, HM 65.1% p = 0.417, although higher rates of success were seen in Type III Achalasia in POEM vs Heller (53.3% vs 44.4%, p < 0.05). Type III Achalasia was the only variable associated with failure on a univariate COX analysis and no covariants were identified on a multivariate Cox regression. There was no statistical difference in GERD symptoms, esophagitis, or major procedural complications.

Conclusion

POEM and HM have similar long-term (4-year) efficacy with similar adverse event and reflux rates. POEM was associated with greater efficacy in Type III Achalasia.

中文翻译：

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经口内镜下肌切开术与腹腔镜海勒肌切开术治疗门失弛缓症的长期结果：单中心经验

摘要

介绍

许多中心报告了经口内镜下肌切开术（POEM）治疗门失弛缓症的短期疗效。但是，长期数据有限，很少有比较POEM与Heller Myotomy（HM）疗效的研究。

目的

为了比较POEM与HM的长期临床疗效。

方法

使用回顾性平行队列设计，评估了2010年至2015年间所有针对OEM门失弛缓症的POEM或HM病例。临床失败的定义为（a）至少4周的Eckardt评分> 3，（b）与失弛缓症相关的住院，或（c）重复干预。通过芝加哥分类法v3对所有索引测度进行分类。审查了术前临床，测压，影像学和程序数据。

结果

确定了98例患者（55例POEM，43例Heller），平均随访时间分别为3。94年和5。44年。83.7％的HM患者接受了相关的抗反流包装（Toupet或Dor）。两组之间的基线临床，人口统计学，放射照相和测压数据相似。总的长期成功率无统计学差异（POEM为72.7％，HM 65.1％p  = 0.417，尽管POEM与Heller的III型口疮病的成功率更高（53.3％对44.4％，p  <0.05）。在单因素COX分析中，III型口疮是唯一与失败相关的变量，在多因素Cox回归中未发现协变量，GERD症状，食管炎或主要手术并发症均无统计学差异。

结论

POEM和HM具有相似的长期（4年）疗效，并具有相似的不良事件和返流率。POEM在III型口疮中具有更高的疗效。