경구 내시경적 근절개술, 식도이완불능증, Peroral endoscopic myotomy for achalasia

Laparoscopic Heller myotomy (LHM)은 achalasia에서 가장 일반적으로 시행되는 수술 방법입니다. Peroral endoscopic myotomy(POEM)는 외과적 절개술과 동등한 내시경 방법이며 새로운 기술입니다. 두 가지 방법을 비교한 코호트 연구에 대한 메타 분석에서 POEM은 연하곤란 완화에 있어 LHM보다 약간 더 효과적이었지만 pathologic reflux의 발생률이 더 높았고 병원 입원 기간이 약간 더 길었습니다. 두 가지 방법 모두 수술 1년 후 90 % 이상의 환자에서 연하곤란이 개선되었습니다. 환자는 이용 가능한 지역 자원과 선호도에 따라 방법을 선택할 수 있지만, 비교적 새로운 절차이므로 POEM의 장기적인 효과가 알려지지 않았음을 이해해야 합니다.

The efficacy and safety of POEM has been compared with that of laparoscopic Heller myotomy (LHM). In a meta-analysis of over 7000 patients in over 70 cohort studies, POEM was more effective than LHM in relieving dysphagia. Predicted probabilities for improvement in dysphagia at 12 months were 93.5 percent for POEM and 91.0 percent for LHM, and at 24 months were 92.7 percent for POEM and 90.0 percent for LHM; both differences were statistically significant. However, POEM was associated with higher incidences of pathologic reflux by multiple measurements (symptoms, erosive esophagitis, and abnormal pH studies) and a slightly longer hospital stay (by one day) than LHM. Studies on LHM had significantly longer follow-up than POEM (41.5 versus 16.2 months); longer-term data on POEM are required before the durability of the two procedures can be directly compared. Until then, patients eligible for both procedures may choose one based on the clinical situation, available local resources, and patient/surgeon preference.

REF. UpToDate 2018.06.10