目的:接受经口内镜下肌切开术(POEM)的患者的术后即刻和长期管理存在显着差异,主要是由于缺乏高质量的证据。我们旨在通过改良的Delphi程序就POEM后患者的护理后几个重要问题达成共识。
方法:一个指导委员会开发了一个初始问卷,包括5个领域(33个声明):POEM后入学/出院,POEM后食管的即时指征,围手术期药物和饮食恢复,临床随访建议,以及POEM后回流的监测和管理。共有34名专家参加了德尔菲程序的2轮,对每一轮的定量和定性数据进行分析,以达成共识。
结果:共有23个陈述达成了高度共识。总的来说,专家小组就以下内容达成一致:(1)POEM后当天出院可考虑在部分患者中,(2)单剂量预防性抗生素可能与短期疗程一样有效,(3)改良饮食可作为晚期耐受,(4)所有患者均应在临床上进行随访,并接受客观检查以监测和管理反流。无法就POEM后食管图的指示达成共识,以评估泄漏。
结论:此Delphi程序的结果在几个重要问题上建立了专家共识,并在POEM后患者护理的关键方面提供了实用指导。
OBJECTIVE: There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (
POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a
consensus on several important questions on the after care of post-
POEM patients through a modified Delphi process.
METHODS: A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management. A total of 34 experts participated in the 2 rounds of the Delphi process, with quantitative and qualitative data analyzed for each round to achieve
consensus.
RESULTS: A total of 23 statements achieved high degree of
consensus. Overall, the expert panel agreed on the following: (1) same-day discharge after POEM can be considered in select patients, (2) a single dose of prophylactic antibiotics may be as effective as a short course, (3) a modified diet can be advanced as tolerated, (4) all patients should be followed in clinic and undergo objective testing for surveillance and management of reflux.
Consensus could not be achieved on the indication of post-
POEM esophagram to evaluate for leak.
CONCLUSIONS: The results of this Delphi process established expert agreement on several important issues and provides a practical guidance on key aspects in the care of patients following POEM.