Abstract：
OBJECTIVE: Peroral endoscopic myotomy (POEM) has become the first line treatment for achalasia, but controversies remain about the prevalence of gastro-esophageal reflux disease (GERD) after the procedure. The aim of this study was to evaluate post-POEM GERD by a retrospective analysis of a single center cohort.
METHODS: Achalasia patients aged 18 or above, who underwent POEM between 2012 and 2021, were included, provided they had an endoscopic control of reflux at least one year after POEM. GERD symptoms based on GerdQ questionnaire, and proton pomp inhibitors (PPI) consumption were also evaluated.
RESULTS: Among a consecutive cohort of 422 patients treated by POEM, 254 patients were included. Endoscopic results were available after a mean follow-up of 1.9 ± 1.5 years. 71/254 patients (28 %) had erosive esophagitis (86 % Los Angeles Grade A or B). At the last follow-up (mean 4.5 ± 2.2 years), clinical success of POEM (Eckardt score ≤ 3) was achieved in 79.5 % of patients. 44.5 % of patients were on PPI. Mean GerdQ score was 2.2 ± 2.7, with only 13 patients (6.5 %) with a score ≥ 8.
CONCLUSIONS: In this cohort of achalasia patients with an endoscopic follow-up at least 1 year after POEM, GERD did not appear a major threat concern: clinical symptoms were mild in most cases, as was the degree of erosive esophagitis. Furthermore, at the time of last follow up, less than half of patients required treatment with PPI.
METHODS: Achalasia patients aged 18 or above, who underwent POEM between 2012 and 2021, were included, provided they had an endoscopic control of reflux at least one year after POEM. GERD symptoms based on GerdQ questionnaire, and proton pomp inhibitors (PPI) consumption were also evaluated.
RESULTS: Among a consecutive cohort of 422 patients treated by POEM, 254 patients were included. Endoscopic results were available after a mean follow-up of 1.9 ± 1.5 years. 71/254 patients (28 %) had erosive esophagitis (86 % Los Angeles Grade A or B). At the last follow-up (mean 4.5 ± 2.2 years), clinical success of POEM (Eckardt score ≤ 3) was achieved in 79.5 % of patients. 44.5 % of patients were on PPI. Mean GerdQ score was 2.2 ± 2.7, with only 13 patients (6.5 %) with a score ≥ 8.
CONCLUSIONS: In this cohort of achalasia patients with an endoscopic follow-up at least 1 year after POEM, GERD did not appear a major threat concern: clinical symptoms were mild in most cases, as was the degree of erosive esophagitis. Furthermore, at the time of last follow up, less than half of patients required treatment with PPI.
摘要：
目的：经口内镜下肌切开术（POEM）已成为门失弛缓症的一线治疗方法，但术后胃食管反流病(GERD)的患病率仍存在争议.这项研究的目的是通过对单中心队列的回顾性分析来评估POEM后GERD。
方法：18岁或以上的贲门失弛缓症患者，包括在2012年至2021年期间接受POEM的人，前提是他们在POEM后至少一年内对反流进行了内镜控制。基于GerdQ问卷的GERD症状，和质子排挤抑制剂（PPI）的消耗也进行了评估。
结果：在接受POEM治疗的422例患者的连续队列中，254名患者被包括在内。平均随访1.9±1.5年后可获得内窥镜检查结果。71/254例患者（28%）患有糜烂性食管炎（86%洛杉矶A级或B级）。在最后一次随访（平均4.5±2.2年），79.5%的患者获得了POEM的临床成功(Eckardt评分≤3分).44.5%的患者使用PPI。平均GerdQ评分为2.2±2.7，只有13名患者（6.5％）的评分≥8。
结论：在POEM后至少1年进行内镜随访的门失弛缓症患者队列中，GERD没有出现主要的威胁问题：在大多数情况下，临床症状是轻微的，糜烂性食管炎的程度也是如此。此外，在最后一次跟进的时候，不到一半的患者需要PPI治疗.
方法：18岁或以上的贲门失弛缓症患者，包括在2012年至2021年期间接受POEM的人，前提是他们在POEM后至少一年内对反流进行了内镜控制。基于GerdQ问卷的GERD症状，和质子排挤抑制剂（PPI）的消耗也进行了评估。
结果：在接受POEM治疗的422例患者的连续队列中，254名患者被包括在内。平均随访1.9±1.5年后可获得内窥镜检查结果。71/254例患者（28%）患有糜烂性食管炎（86%洛杉矶A级或B级）。在最后一次随访（平均4.5±2.2年），79.5%的患者获得了POEM的临床成功(Eckardt评分≤3分).44.5%的患者使用PPI。平均GerdQ评分为2.2±2.7，只有13名患者（6.5％）的评分≥8。
结论：在POEM后至少1年进行内镜随访的门失弛缓症患者队列中，GERD没有出现主要的威胁问题：在大多数情况下，临床症状是轻微的，糜烂性食管炎的程度也是如此。此外，在最后一次跟进的时候，不到一半的患者需要PPI治疗.
