PDF(Pubmed)
Abstract：
In this editorial, we respond to a review article by Nabi et al, in which the authors discussed gastroesophageal reflux (GER) following peroral endoscopic myotomy (POEM). POEM is presently the primary therapeutic option for achalasia, which is both safe and effective. A few adverse effects were documented after POEM, including GER. The diagnostic criteria were not clear enough because approximately 60% of patients have a long acid exposure time, while only 10% experience reflux symptoms. Multiple predictors of high disease incidence have been identified, including old age, female sex, obesity, and a baseline lower esophageal sphincter pressure of less than 45 mmHg. Some technical steps during the procedure, such as a lengthy or full-thickness myotomy, may further enhance the risk. Proton pump inhibitors are currently the first line of treatment. Emerging voices are increasingly advocating for the routine combining of POEM with an endoscopic fundoplication method, such as peroral endoscopic fundoplication or transoral incisionless fundoplication. However, more research is necessary to determine the safety and effectiveness of these procedures in the long term for patients who have undergone them.
摘要：
在这篇社论中，我们回应了Nabi等人的一篇评论文章，其中作者讨论了经口内镜下肌切开术（POEM）后的胃食管反流（GER）。POEM目前是贲门失弛缓症的主要治疗选择，既安全又有效。POEM后记录了一些不良反应，包括GER。诊断标准不够明确，因为大约60%的患者有很长的酸暴露时间，而只有10%的人出现反流症状。已经确定了高疾病发病率的多个预测因素，包括老年，女性性别,肥胖，基线食管下括约肌压力小于45mmHg。程序中的一些技术步骤，如长时间或全层肌切开术，可能会进一步增强风险。质子泵抑制剂目前是一线治疗。新兴的声音越来越多地提倡将POEM与内窥镜胃底折叠术相结合，如经口内镜胃底折叠术或经口无切口胃底折叠术。然而,需要更多的研究来确定这些手术对接受这些手术的患者的长期安全性和有效性.
