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首页> 外文期刊>Surgical Endoscopy >Peroral endoscopic myotomy leads to higher rates of abnormal esophageal acid exposure than laparoscopic Heller myotomy in achalasia
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Peroral endoscopic myotomy leads to higher rates of abnormal esophageal acid exposure than laparoscopic Heller myotomy in achalasia

机译：情节内镜肌动术导致患有腹腔镜的异常食管酸暴露的速率高于贲门大教堂

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Background and aimsPeroral endoscopic myotomy (POEM) may be associated with higher rates of gastroesophageal reflux disease (GERD) than laparoscopic Heller's myotomy with fundoplication (LHM), since POEM is not combined with a fundoplication. However, peri-esophageal anti-reflux barriers are preserved in POEM, which might prevent GERD. Hence, we sought to compare the objective esophageal pH study findings in achalasia patients after POEM and LHM.MethodsAchalasia patients undergoing POEM from 2014 to 2015at our institution were matched 1:3 with LHM patients using propensity score matching. Demographics, prior interventions, pre-treatment and 2-month post-treatment timed barium esophagram (TBE), high-resolution esophageal manometry (HREM) and 24-h esophageal pH study findings were compared between the two groups.ResultsThirty-one patients in the POEM group and 88 patients in the LHM group were included. Larger proportion of POEM patients had prior interventions for achalasia as compared to LHM patients (overall: 71% vs. 44.3%; p=0.012). Esophageal acid exposure was significantly higher in POEM as compared to LHM patients (abnormal total acid exposure: 48.4% vs. 13.6%; p<0.001, abnormal DeMeester score 54.8% vs. 17.4%; p=0.005 respectively). In sub-group analysis, similar results were noted on 24-h pH study after exclusion of the POEM patients with prior LHM and corresponding matches. There was no significant difference in the rate of GERD symptoms between POEM and LHM. There was no significant correlation between the post-treatment basal lower esophageal sphincter pressure and integrated relaxation pressure with abnormal acid exposure in either POEM or LHM.ConclusionsIn patients with achalasia, POEM leads to significantly higher rates of abnormal esophageal acid exposure, without an increase in the rate of GERD symptoms, when compared to LHM with fundoplication. Interestingly, prior LHM has no impact on post-POEM pH study findings. Potential of increased esophageal acid exposure and possible consequences should be discussed with all patients prior to POEM. Further studies are needed to determine the long-term effects of increased acid exposure after POEM.
机译：背景和Aimsperoral内窥镜肌动术（POEM）可能与腹腔镜回流疾病（GERD）的较高率相关，而腹腔镜HELLer的肌肌瘤与基本软件（LHM），因为诗不与基础策略合并。然而，在诗歌中保留了血管抗反动障碍，这可能会阻止凸起。因此，我们试图在诗歌和LHM患者中比较贲门划分患者的客观食管pH研究发现。从2014年到2015年接受诗歌的患者，我们的机构与LHM患者使用倾向得分匹配匹配1：3。在两组的比较两组之间，在两组中比较了人口统计学，先前干预措施，预治疗和治疗后2个月的治疗后的治疗后钡食子药（TBE）和24-H食管pH研究结果。患者包括LHM组的诗集组和88名患者。与LHM患者相比，较大比例的诗患者对贲门划分症进行了前期干预措施（总体：71％vs.4.3％; P = 0.012）。与LHM患者相比，食管酸暴露在诗中显着较高（异常总酸暴露：48.4％与13.6％; P <0.001，异常的Demeester分别比分别为54.8％; P = 0.005）。在亚组分析中，在排除POEM患者之前，在24小时pH研究中注意到了类似的结果，并在诗歌中排除了POEM患者和相应的匹配。诗和LHM之间的GERD症状率没有显着差异。治疗后基础食管括约肌括号压力和综合放松压力在任何一种痘痘或LHM中的异常酸暴露之间没有显着的相关性。结论患者患者患者，诗歌导致异常食管酸暴露的速率明显较高，而不会增加与LHM与GoodProplys相比，GERD症状的速率。有趣的是，先前的LHM对诗歌后PH研究结果没有影响。在诗之前，应讨论增加食管酸暴露的潜力和可能的所有患者。需要进一步的研究来确定诗后酸暴露的长期影响。

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