背景:贲门失弛缓症是一种食管运动性障碍,有三种亚型,基于测压,可以通过经口内镜肌切开术(POEM)治疗。随着阻抗平面分析法(EndoFLIP®)的出现,我们假设三种贲门失弛缓亚型在POEMEndoFLIP®前的直径和扩张指数(DI)测量值不同,但在POEM后的测量值相似.
方法:单一机构,从2017年04月07日至2023年08月28日,由单个外科医生-内窥镜医师团队对连续POEM病例进行回顾性审查。根据POEM前测压法,将诊断为门失弛缓症的患者分为1型、2型或3型。患者特征,Eckardt得分,前后POEM直径和DI按亚型与描述性进行比较,单变量,和多元线性回归统计。
结果:64例患者符合纳入标准,其中9人(14.1%)为1型,36人(56.3%)为2型,19人(29.7%)为3型。就POEM前Eckardt得分中位数而言,类型之间没有差异(9[IQR:7-9)与8[IQR:6-9]vs.7[IQR:5-8],p=0.148),POEM后Eckardt得分中位数(0[IQR:0-1]vs.0[IQR:0-0]vs.0[IQR0-0.5],p=0.112)。EndoFLIP®数据显示,亚型之间POEM前直径和DI的中位数变化(6.9[IQR:6-8.5]与5.5[IQR:5-6.8]vs.5[IQR:5-6.1],p=0.025和1.8[IQR:1.3-3.2]vs.0.9[IQR:0.6-1.6]vs.0.6[IQR:0.5-0.8],p=0.003,分别),但不在POEM后的直径或DI变化中(5.1[IQR:4.3-5.9]与5.1[IQR:4.1-7.1]vs.5.9[IQR:5-6.4],p=0.217和3.9[IQR:2.5-4.7]vs.3.4[IQR:2.4-4.7]vs.2.7[IQR:2.3-3.7],分别为p=0.461)。然而,在调整了潜在的混杂因素后,POEM前后的直径和DI在亚型之间没有统计学上的显着差异。
结论:贲门失弛缓亚型没有表现出不同的POEM前直径或通过EndoFLIP®测量的DI,POEM完成后也没有差异。虽然贲门失弛缓症亚型根据测压结果可能具有略有不同的病理生理学,类似的POEM前和后阻抗平面测量结果,还有类似的Eckardt分数,支持使用POEM治疗任何贲门失弛缓症亚型。
BACKGROUND: Achalasia is an esophageal motility disorder with three subtypes based on manometry that can treated with per-oral endoscopic myotomy (POEM). With the advent of impedance planimetry (EndoFLIP®), we hypothesized the three achalasia subtypes would have different pre-POEM EndoFLIP® diameter and distensibility index (DI) measurements but would be similar after POEM.
METHODS: A single-institution, retrospective review of consecutive POEM cases by a single surgeon-endoscopist team from 04/07/2017 to 08/28/2023. Patients with a diagnosis of achalasia were stratified into type 1, 2, or 3 based on pre-POEM manometry. Patient characteristics, Eckardt scores, and pre-and-post-POEM diameter and DI were compared by subtype with descriptive, univariate, and multivariable linear regression statistics.
RESULTS: Sixty-four patients met inclusion criteria, of whom 9(14.1%) had Type 1, 36(56.3%) had Type 2, and 19(29.7%) had Type 3. There were no differences between Types with respect to median pre-POEM Eckardt scores (9[IQR:7-9) vs. 8[IQR:6-9] vs. 7[IQR:5-8], p = 0.148), median post-POEM Eckardt scores (0[IQR:0-1] vs. 0[IQR:0-0] vs. 0[IQR0-0.5], p = 0.112). EndoFLIP® data revealed variation in median pre-POEM diameter and DI between Subtypes (6.9[IQR:6-8.5] vs. 5.5[IQR:5-6.8] vs. 5[IQR:5-6.1], p = 0.025 and 1.8[IQR:1.3-3.2] vs. 0.9[IQR:0.6-1.6] vs. 0.6[IQR:0.5-0.8], p = 0.003, respectively), but not in the change in diameter or DI post-POEM (5.1[IQR:4.3-5.9] vs. 5.1[IQR:4.1-7.1] vs. 5.9[IQR:5-6.4], p = 0.217 and 3.9[IQR:2.5-4.7] vs. 3.4[IQR:2.4-4.7] vs. 2.7[IQR:2.3-3.7], p = 0.461, respectively). However, after adjusting for potentially confounding factors, pre- or post-POEM diameter and DI did not demonstrate statistically significant differences among subtypes.
CONCLUSIONS: Achalasia subtypes did not demonstrate different pre-POEM diameters or DI as measured by EndoFLIP® nor are there differences after POEM completion. While achalasia subtypes may have slightly different pathophysiology based on manometry findings, similar pre- and post-POEM impedance planimetry findings, along with similar Eckardt scores, support the use of POEM in the treatment of any achalasia subtype.