Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial  

作　　者：Eduardo Turiani Hourneaux de Moura Jose Jukemura Igor Braga Ribeiro Galileu Ferreira Ayala Farias Aureo Augusto de Almeida Delgado Lara Meireles Azeredo Coutinho Diogo Turiani Hourneaux de Moura Rubens Antonio Aissar Sallum Ary Nasi Sergio A Sanchez-Luna Paulo Sakai Eduardo Guimaraes Hourneaux de Moura 

机构地区：[1]Departamento de Gastroenterologia,Faculdade de Medicina,Universidade de Sao Paulo,Servico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSP,Sao Paulo 05403-010,Brazil [2]Division of Esophageal Surgery,Hospital das Clinicas,University of Sao Paulo School of Medicine,Sao Paulo 05403-010,Brazil [3]Departamento de Gastroenterologia,Faculdade de Medicina,Universidade de Sao Paulo,Hospital das Clinicas,University of Sao Paulo School of Medicine,Sao Paulo 05403-010,Brazil [4]Department of Internal Medicine,The University of Alabama at Birmingham Heersink School of Medicine,Basil I.Hirschowitz Endoscopic Center of Excellence,Division of Gastroenterology and Hepatology,Birmingham,AL 35233,United States

出　　处：《World Journal of Gastroenterology》2022年第33期4875-4889,共15页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND Achalasia is a rare benign esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter(LES). The treatment of achalasia is not curative, but rather is aimed at reducing LES pressure. In patients who have failed noninvasive therapy, surgery should be considered. Myotomy with partial fundoplication has been considered the first-line treatment for non-advanced achalasia. Recently, peroral endoscopic myotomy(POEM), a technique that employs the principles of submucosal endoscopy to perform the equivalent of a surgical myotomy,has emerged as a promising minimally invasive technique for the management of this condition.AIM To compare POEM and laparoscopic myotomy and partial fundoplication(LM-PF) regarding their efficacy and outcomes for the treatment of achalasia.METHODS Forty treatment-naive adult patients who had been diagnosed with achalasia based on clinical and manometric criteria(dysphagia score ≥ II and Eckardt score > 3) were randomized to undergo either LM-PF or POEM. The outcome measures were anesthesia time, procedure time, symptom improvement, reflux esophagitis(as determined with the Gastroesophageal Reflux Disease Questionnaire), barium column height at 1 and 5 min(on a barium esophagogram), pressure at the LES, the occurrence of adverse events(AEs), length of stay(LOS), and quality of life(QoL).RESULTS There were no statistically significant differences between the LM-PF and POEM groups regarding symptom improvement at 1, 6, and 12 mo of follow-up(P = 0.192, P = 0.242, and P = 0.242, respectively). However, the rates of reflux esophagitis at 1, 6, and 12 mo of follow-up were significantly higher in the POEM group(P = 0.014, P < 0.001, and P = 0.002, respectively). There were also no statistical differences regarding the manometry values, the occurrence of AEs, or LOS. Anesthesia time and procedure time were significantly shorter in the POEM group than in the LM-PF group(185.00 ± 56.89 and 95.70 ± 30.47 min vs 296.75 ± 56.13 and 218.75 ± 50.88 min,re

关 键 词：Esophageal achalasia Gastroesophageal reflux Deglutition disorders Heller myotomy FUNDOPLICATION Randomized controlled trial 

分 类 号：R655.4[医药卫生—外科学]