PDF(Pubmed)
Abstract：
Achalasia, a rare esophageal motility disorder characterized by the inability of the lower esophageal sphincter to relax and loss of esophageal peristalsis, significantly impacts pediatric patient quality of life through symptoms like dysphagia, chest pain, and weight loss. This nationwide retrospective cohort study evaluates the efficacy and safety of peroral endoscopic myotomy (POEM) for pediatric achalasia in Mongolia, contributing to the limited global data on this minimally invasive treatment in children. Conducted between February 2020 and March 2022 at 2 tertiary centers, the study included symptomatic achalasia patients, treatment-naive or those with unsatisfactory outcomes from previous esophageal dilations. The POEM procedure was assessed for its impact on esophageal structure and function, symptom severity via the Eckardt score, and procedure-related safety, with outcomes measured at baseline, 3 days, and 12 months post-procedure. The study demonstrated notable post-procedure improvements across all measured outcomes: abnormal contraction length and esophageal width significantly reduced, underscoring the procedure\'s effectiveness. More precisely, the integrated relaxation pressure showed a significant improvement from a mean of 26.8 mm Hg (standard deviation [SD], 5.4 mm Hg) pre-procedure to 10.8 mm Hg (SD, 1.1 mm Hg) 12 months (P < .001). Similarly, Eckardt scores, which assess symptom severity, improved significantly from a pre-procedure mean of 7.0 (SD, 1.0) to a substantially lower score post-procedure (P < .001), reflecting enhanced patient quality of life and symptom alleviation. This study underscores POEM\'s role as an effective, minimally invasive option for pediatric achalasia management within the Mongolian population, offering significant symptomatic relief and improved esophageal function.
摘要：
腹胀症,一种罕见的食管运动障碍，其特征是食管下括约肌无法放松和食管蠕动丧失，通过吞咽困难等症状显著影响儿科患者的生活质量，胸痛,和减肥。这项全国性的回顾性队列研究评估了经口内镜下肌切开术（POEM）治疗蒙古儿童贲门失弛缓症的疗效和安全性。对这种儿童微创治疗的全球数据有限。在2020年2月至2022年3月期间在2个三级中心进行，这项研究包括有症状的门失弛缓症患者，未接受治疗或以前食管扩张结果不满意的患者。评估POEM程序对食管结构和功能的影响，症状严重程度通过Eckardt评分,和程序相关的安全，在基线测量的结果，3天,术后12个月。研究表明，在所有测量结果中，术后显着改善：异常收缩长度和食管宽度显着减少，强调程序的有效性。更确切地说,积分松弛压力显示出比26.8mmHg的平均值有显著改善(标准偏差[SD]，5.4mmHg）至10.8mmHg（SD，1.1mmHg）12个月（P<.001）。同样，Eckardt得分,评估症状严重程度，从术前平均值7.0(SD，1.0)术后得分低得多(P<.001)，反映了患者生活质量的提高和症状的缓解。这项研究强调了POEM作为一种有效的，蒙古人群中小儿贲门失弛缓症的微创治疗方案，提供显著的症状缓解和改善食管功能。
