Background

Peroral endoscopic myotomy (POEM) has emerged as a widely accepted treatment for achalasia, with limited studies for over 2 years. Additionally, traditional measurements of achalasia after POEM have deficiencies. The study aimed to analyze the long-term outcomes of POEM under different criteria.

Methods

Patients with achalasia who received POEM between November 2012 and March 2021 were recruited. Patients and characteristics were shown, and risk factors related to two novel definitions of recurrence, symptomatic reflux, and reflux esophagitis were analyzed.

Results

Three hundred and twenty-one patients were included. At a median follow-up of 52 months, twenty-three failures happened (7.17%) under the modified criterion, and forty-seven failures occurred (14.64%) under the normal standard. Hospitalization (P = 0.027) and esophageal myotomy length (P = 0.039) were significantly associated with long-term efficacy under the modified and normal criteria, respectively. Fifty-two patients (16.20%) reported reflux symptoms and endoscopy performed in 88 patients revealed reflux esophagitis in 22 cases (25.00%). There were no predictors in the analysis of symptomatic reflux and gender (P = 0.010), LESP (P = 0.013), IRP (P = 0.015), and the esophageal myotomy length (P = 0.032) were statistically related to reflux esophagitis.

Conclusion

POEM is an extremely safe and effective treatment for achalasia with long-term follow-up. Shorter hospitalization and shorter esophageal myotomy length may decrease the incidence of recurrence under the modified and normal criteria, respectively. Long-term outcomes of POEM are unpredictable. No risk factors were related to symptomatic reflux, and male patients with low preoperative LESP and IRP needed relatively shorter esophageal myotomy to prevent reflux esophagitis.

中文翻译：

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不同标准下经口内镜肌切开术治疗贲门失弛缓症的长期疗效

背景

经口内窥镜肌切开术 (POEM) 已成为广泛接受的贲门失弛缓症治疗方法，但两年多以来的研究有限。此外，POEM 后贲门失弛缓症的传统测量方法也存在缺陷。该研究旨在分析不同标准下 POEM 的长期结果。

方法

招募了 2012 年 11 月至 2021 年 3 月期间接受 POEM 的贲门失弛缓症患者。显示了患者和特征，并分析了与复发、症状性反流和反流性食管炎这两个新定义相关的危险因素。

结果

其中包括三百二十一名患者。中位随访52个月时，修改标准下发生23例失败（7.17%），正常标准下发生47例失败（14.64%）。住院治疗（P  = 0.027）和食管肌切开术长度（P  = 0.039）分别与修改标准和正常标准下的长期疗效显着相关。52 例患者（16.20%）报告有反流症状，88 例患者进行内镜检查发现反流性食管炎 22 例（25.00%）。症状反流与性别（ P  = 0.010）、LESP（P  = 0.013）、IRP（P  = 0.015）和食管肌切开长度（P = 0.032）的分析中没有预测因素 与反流性食管炎有统计学相关。

结论

POEM 是一种极其安全有效的贲门失弛缓症治疗方法，可进行长期随访。缩短住院时间和缩短食管肌切开术长度可能分别降低修改标准和正常标准下的复发率。POEM 的长期结果是不可预测的。没有与症状反流相关的危险因素，术前 LESP 和 IRP 较低的男性患者需要相对较短的食管肌切开术来预防反流性食管炎。