PDF(Pubmed)
Abstract：
This editorial is an analysis the review article by Nabi et al recently published in this journal. Achalasia Cardia is a disease whose pathophysiology is still unclear. It is known that there is inflammation of unknown aetiology leading to loss of ganglion cells in the muscularis propria. The end result is lower oesophageal sphincter spasm, loss of receptive relaxation, decreased oesophageal peristalsis, all leading on to varying degrees of dysphagia. The treatment of this condition is palliative in nature, performed by myotomy of the lower oesophagus either surgically or endoscopically. Gastroesophageal reflux disease (GERD) has been associated with the myotomy performed, particularly with the Peroral Endoscopic Myotomy (POEM) procedure. Nabi et al have provided an excellent overview of the latest developments in predicting, preventing, evaluating, and managing GERD subsequent to POEM. Based on this theme, this review article explores the concept of using histology of the oesophageal muscle layer, to grade the disease and thereby help tailoring the length/type of myotomy performed during the POEM procedure. In the future, will a histology based algorithm available preoperatively, help modify the POEM procedure, thereby decreasing the incidence of GERD associated with POEM?
摘要：
这篇社论是Nabi等人最近在本杂志上发表的评论文章的分析。贲门失弛缓症是一种病理生理学尚不清楚的疾病。已知存在病因不明的炎症,导致固有肌层中神经节细胞的损失。最终结果是食管下括约肌痉挛，失去接受性放松，食管蠕动减少，都导致不同程度的吞咽困难。这种情况的治疗本质上是姑息的，通过手术或内窥镜对下食管进行肌切开术。胃食管反流病（GERD）与肌切开术有关，特别是经口内窥镜肌切开术（POEM）程序。Nabi等人对预测的最新进展提供了极好的概述，预防,评估，并在POEM之后管理GERD。基于这个主题,这篇综述文章探讨了使用食管肌层组织学的概念，对疾病进行分级，从而帮助调整POEM手术过程中进行的肌切开术的长度/类型。在未来,将术前可用的基于组织学的算法，帮助修改POEM过程，从而降低与POEM相关的GERD的发病率？
