经口内镜下肌切开术（POEM）治疗老年贲门失弛缓症的结果：单机构回顾性队列研究。

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中文摘要

背景： POEM已被证明在成人中具有优异的安全性和有效性。我们报告了POEM治疗老年患者（65岁或以上）贲门失弛缓症的经验。
方法： 这是一项为期4年的单机构回顾性队列研究。主要结局是临床成功，定义为吞咽困难评分改善至≤1且在前6个月内无需再次干预。次要结局包括技术成功、再干预率和术后并发症。
结果： 共有51例患者（男性52.9%，平均年龄：72.9±6.2岁；范围65至91岁）接受了POEM治疗贲门失弛缓症。大多数患者[n=27（52.9%）]为贲门失弛缓症II型，而13例（25.5%）为I型，11例（21.6%）为III型。技术成功率达到100%（n=51），临床成功率达到96.1%（n=49）。中位吞咽困难评分从术前3分（IQR=1至3）显著改善至最近一次随访时的0分（IQR=0至0）（P<0.001）。中位反流评分也从术前1分（IQR=0至2）改善至术后最近一次随访时的0分（IQR=0至0）（P<0.001）。在平均9个月（范围：1至37个月）的随访期间，2例患者（3.9%）因症状复发需要再次干预。
结论： POEM是治疗老年患者所有类型贲门失弛缓症的一种安全、有效且持久的治疗方法。

英文摘要

BACKGROUND: POEM has been shown to have excellent safety and efficacy in adults. We report our experience with the POEM for the treatment of achalasia in elderly patients (65 y or older).
METHODS: This is a single-institution retrospective cohort study over a span of 4 years. The primary outcome was clinical success, defined as improvement in dysphagia score to ≤1 without need for a reintervention in the first 6 months. Secondary outcomes included technical success, rate of reintervention, and postprocedural complications.
RESULTS: A total of 51 patients (male 52.9%, mean age: 72.9±6.2 y; range 65 to 91 y) underwent POEM for treatment of achalasia. Most patients [n=27 (52.9%)] had achalasia type II, while 13 (25.5%) had achalasia type I and 11 (21.6%) had achalasia type III. Technical success was achieved in 100% of patients (n=51), and clinical success was achieved in 96.1% of patients (n=49). The median dysphagia score improved significantly from 3 (IQR=1 to 3) preprocedure to 0 (IQR=0 to 0) at the most recent follow-up (P<0.001). Median regurgitation scores also improved from 1 (IQR=0 to 2) preprocedure to 0 (IQR=0 to 0) postprocedure at the most recent follow-up (P<0.001). Reintervention due to recurrence of symptoms was required in 2 patients (3.9%) during a mean length of follow-up of 9 months (range: 1 to 37 mo).
CONCLUSION: POEM is a safe, effective, and durable treatment for all types of achalasia in elderly patients.