Gastrointestinal endoscopy · 2017
Outcomes of per-oral endoscopic myotomy for treatment of esophageal achalasia with a median follow-up of 49 months.
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Li Quan-Lin, Wu Qiu-Ning, Zhang Xiao-Cen, Xu Mei-Dong, Zhang Wei, Chen Shi-Yao, Zhong Yun-Shi, Zhang Yi-Qun, Chen Wei-Feng, Qin Wen-Zheng, Hu Jian-Wei, Cai Ming-Yan, Yao Li-Qing, Zhou Ping-Hong
Аннотация
BACKGROUND AND AIMS: Per-oral endoscopic myotomy (POEM) has received wide acceptance as a highly effective and safe treatment for esophageal achalasia. Short-term and small-scale studies are ample, but long-term large-scale studies are few. The aim of the study was to systematically analyze our long-term results of POEM, with particular emphasis on POEM failures and associated risk factors.
METHODS: In this single-center study, consecutive patients treated with POEM between August 2010 and December 2012 were included. The Kaplan-Meier survival function was used to estimate clinical success rate at each year. The Cox proportional hazards model was used to analyze risk factors related to recurrence.
RESULTS: A total of 564 patients were included. Major perioperative adverse events occurred in 36 patients (6.4%). After a median follow-up of 49 months (range, 3-68), the Eckardt score and lower esophageal sphincter (LES) pressure were significantly decreased (median Eckardt score, 8 to 2 [P < .05]; median LES pressure, 29.7 mm Hg to 11.9 mm Hg [P < .05]). Fifteen failures occurred within 3 months, 23 between 3 months and 3 years, and 10 after 3 years. The estimated clinical success rates at 1, 2, 3, 4, and 5 years were 94.2%, 92.2%, 91.1%, 88.6%, and 87.1%, respectively. Multivariate Cox regression revealed long disease duration (≥10 years) and history of prior interventions to be risk factors for recurrence. Clinical reflux occurred in 37.3% of patients (155/ 416).
CONCLUSIONS: POEM is a highly safe and effective treatment for esophageal achalasia with favorable long-term outcomes.
METHODS: In this single-center study, consecutive patients treated with POEM between August 2010 and December 2012 were included. The Kaplan-Meier survival function was used to estimate clinical success rate at each year. The Cox proportional hazards model was used to analyze risk factors related to recurrence.
RESULTS: A total of 564 patients were included. Major perioperative adverse events occurred in 36 patients (6.4%). After a median follow-up of 49 months (range, 3-68), the Eckardt score and lower esophageal sphincter (LES) pressure were significantly decreased (median Eckardt score, 8 to 2 [P < .05]; median LES pressure, 29.7 mm Hg to 11.9 mm Hg [P < .05]). Fifteen failures occurred within 3 months, 23 between 3 months and 3 years, and 10 after 3 years. The estimated clinical success rates at 1, 2, 3, 4, and 5 years were 94.2%, 92.2%, 91.1%, 88.6%, and 87.1%, respectively. Multivariate Cox regression revealed long disease duration (≥10 years) and history of prior interventions to be risk factors for recurrence. Clinical reflux occurred in 37.3% of patients (155/ 416).
CONCLUSIONS: POEM is a highly safe and effective treatment for esophageal achalasia with favorable long-term outcomes.
Предметные рубрики MeSH
AdolescentAdultAgedChildCohort StudiesEndoscopy, Digestive SystemEsophageal AchalasiaEsophageal Sphincter, LowerFemaleFollow-Up StudiesGastroesophageal RefluxHumansKaplan-Meier EstimateMaleManometryMiddle AgedMultivariate AnalysisMyotomyNatural Orifice Endoscopic SurgeryPostoperative ComplicationsProportional Hazards ModelsPyloromyotomyRecurrenceTreatment OutcomeYoung Adult