Abstract：
OBJECTIVE: To explore the feasibility of peroral endoscopic myotomy (POEM) in patients with achalasia and hiatal hernia.
METHODS: We performed a retrospective review of 2136 patients with achalasia between January 2016 and December 2022. Patients with achalasia and hiatal hernia were assigned into study group, and matched patients with achalasia but no hiatal hernia were assigned into control group. The preoperative baseline information, procedure-related adverse events (AEs) and follow-up data were compared between the two groups.
RESULTS: Hiatal hernia was identified in 56/1564 (3.6%) patients with achalasia. All of these patients underwent POEM with success. The preoperative baseline characteristics were similar between the study and control group. The study group presented with a similar rate of mucosal injury (12.5% vs 16.1, P = 0.589), pneumothorax (3.6% vs 1.8%, P = 1.000), pleural effusion (8.9% vs 12.5%, P = 0.541) and major AEs (1.8% vs 1.8%, P = 1.000) compared with the control group. As for the follow-up data, no significant differences were observed in clinical success (96.4% vs 92.9%, P = 0.679; 93.6% vs 94.0%, P = 1.000; 86.5% vs 91.4%, P = 0.711) clinical reflux (25.0% vs 19.6%, P = 0.496; 31.9% vs 26.0%, P = 0.521; 35.1% vs 31.4%, P = 0.739) and proton pump inhibitor usage (17.9% vs 16.1%, P = 0.801; 29.8% vs 24.0%, P = 0.520; 32.4% vs 25.7%, P = 0.531) between the study group and control group at 1-year, 2-year and 3-year follow-ups.
CONCLUSIONS: POEM is a safe and effective treatment for achalasia combined with hiatal hernia.
METHODS: We performed a retrospective review of 2136 patients with achalasia between January 2016 and December 2022. Patients with achalasia and hiatal hernia were assigned into study group, and matched patients with achalasia but no hiatal hernia were assigned into control group. The preoperative baseline information, procedure-related adverse events (AEs) and follow-up data were compared between the two groups.
RESULTS: Hiatal hernia was identified in 56/1564 (3.6%) patients with achalasia. All of these patients underwent POEM with success. The preoperative baseline characteristics were similar between the study and control group. The study group presented with a similar rate of mucosal injury (12.5% vs 16.1, P = 0.589), pneumothorax (3.6% vs 1.8%, P = 1.000), pleural effusion (8.9% vs 12.5%, P = 0.541) and major AEs (1.8% vs 1.8%, P = 1.000) compared with the control group. As for the follow-up data, no significant differences were observed in clinical success (96.4% vs 92.9%, P = 0.679; 93.6% vs 94.0%, P = 1.000; 86.5% vs 91.4%, P = 0.711) clinical reflux (25.0% vs 19.6%, P = 0.496; 31.9% vs 26.0%, P = 0.521; 35.1% vs 31.4%, P = 0.739) and proton pump inhibitor usage (17.9% vs 16.1%, P = 0.801; 29.8% vs 24.0%, P = 0.520; 32.4% vs 25.7%, P = 0.531) between the study group and control group at 1-year, 2-year and 3-year follow-ups.
CONCLUSIONS: POEM is a safe and effective treatment for achalasia combined with hiatal hernia.
摘要：
目的：探讨经口内镜下肌切开术(POEM)治疗贲门失弛缓合并食管裂孔疝的可行性。
方法：我们对2016年1月至2022年12月的2136例贲门失弛缓症患者进行了回顾性研究。将贲门失弛缓症和食管裂孔疝患者分为研究组，与之相匹配的门失弛缓但无食管裂孔疝的患者被分配到对照组。术前基线信息，比较两组手术相关不良事件(AE)和随访数据.
结果：在56/1564（3.6%）门失弛缓症患者中发现食管裂孔疝。所有这些患者都成功接受了POEM。研究组和对照组的术前基线特征相似。研究组的粘膜损伤率相似（12.5％vs16.1，P=0.589），气胸（3.6%vs1.8%，P=1.000),胸腔积液（8.9％vs12.5％，P=0.541)和主要不良事件(1.8%对1.8%，P=1.000）与对照组相比。至于后续数据，临床成功率无显著差异(96.4%vs92.9%，P=0.679;93.6%vs94.0%,P=1.000；86.5%vs91.4%，P=0.711）临床反流（25.0%vs19.6%，P=0.496；31.9%对26.0%，P=0.521；35.1%对31.4%，P=0.739）和质子泵抑制剂使用率（17.9%vs16.1%，P=0.801；29.8%对24.0%，P=0.520；32.4%对25.7%，P=0.531）在1年时研究组和对照组之间，2年和3年随访。
结论：POEM治疗门失弛缓合并食管裂孔疝是一种安全有效的治疗方法。
方法：我们对2016年1月至2022年12月的2136例贲门失弛缓症患者进行了回顾性研究。将贲门失弛缓症和食管裂孔疝患者分为研究组，与之相匹配的门失弛缓但无食管裂孔疝的患者被分配到对照组。术前基线信息，比较两组手术相关不良事件(AE)和随访数据.
结果：在56/1564（3.6%）门失弛缓症患者中发现食管裂孔疝。所有这些患者都成功接受了POEM。研究组和对照组的术前基线特征相似。研究组的粘膜损伤率相似（12.5％vs16.1，P=0.589），气胸（3.6%vs1.8%，P=1.000),胸腔积液（8.9％vs12.5％，P=0.541)和主要不良事件(1.8%对1.8%，P=1.000）与对照组相比。至于后续数据，临床成功率无显著差异(96.4%vs92.9%，P=0.679;93.6%vs94.0%,P=1.000；86.5%vs91.4%，P=0.711）临床反流（25.0%vs19.6%，P=0.496；31.9%对26.0%，P=0.521；35.1%对31.4%，P=0.739）和质子泵抑制剂使用率（17.9%vs16.1%，P=0.801；29.8%对24.0%，P=0.520；32.4%对25.7%，P=0.531）在1年时研究组和对照组之间，2年和3年随访。
结论：POEM治疗门失弛缓合并食管裂孔疝是一种安全有效的治疗方法。
