Akalazya Hastalarında Peroral Endoskopik Miyotominin Etkinliği ve Güvenliği

Year 2024, Volume: 15 Issue: 1, 123 - 130, 28.03.2024

Nermin Mutlu Bilgiç , Zuhal Çalışkan , Oğuzhan Öztürk , Mehmet Ali Saruhan , Kamil Ozdil

https://doi.org/10.18663/tjcl.1443948

Abstract

Amaç: Bu çalışma, akalazya tanısı almış yetişkin hastalarda POEM prosedürünün etkinlik ve komplikasyonlar açısından sonuçlarını sunmayı ve yaş, cinsiyet ve obezite gibi geleneksel risk faktörlerinin bu sonuçlar üzerindeki potansiyel etkilerini araştırmayı amaçlamaktadır.
Gereç ve Yöntemler: Ocak 2021'den Temmuz 2023'e kadar POEM prosedürü geçiren toplam 51 hasta geriye dönük olarak değerlendirildi. Ana sonlanım noktası, prosedürden iki ay sonra Eckardt skorunun 3 veya daha düşük olmasıyla belirlenen klinik başarı oranı olarak değerlendirildi. İkincil sonlanım noktaları, herhangi bir advers olay, yoğun bakım ünitesine kabul ve prosedür sonrası iki ayda reflü semptomlarının varlığı olarak değerlendirildi
Bulgular: Hastaların ortalama yaşı 49,3 ± 13,3 yıl idi ve semptomların süresi 6 ay ile 10 yıl arasında değişiyordu. Ameliyat öncesi medyan Eckardt skorları 9 idi ve 5 ile 12 arasında değişiyordu. Prosedür sonrası 2. ayda hastaların %96,1'i 3 veya daha düşük bir Eckardt skoruna sahipti, medyan 8 puanlık bir azalma ile (IQR = 6 – 8, p < 0.001). Hastaların %13,7'si advers olaylarla karşılaştı, bunların %3,9'u pnömomediastinum, %1,9'u mediastinit ve %1,9'u tünel içi kanama içeriyordu. Prosedür sonrası 2. ayda hastaların %17,6'sı reflü özofajiti sergiledi. Hiçbir hastada mortalite gözlenmedi.
Sonuçlar: POEM, akalazya için etkili, güvenli ve minimal invaziv bir tedavi olup, semptomatik rahatlama, yaşam kalitesinde iyileşme sunan ve yüksek klinik başarı oranı ile umut verici bir terapötik seçenek olarak öne çıkmaktadır. Düşük oranda gözlenen advers olaylar yönetilebilir düzeydeydi ve mortaliteye neden olmadı.

Keywords

Akalazya, endoskopi, peroral endoskopik miyotomi, miyotomi

Project Number

292

Effectiveness and safety of peroral endoscopic myotomy in patients with achalasia

Abstract

Aim: This study aimed to present the outcomes in terms of efficacy and complications of the POEM procedure in adult patients diagnosed with achalasia and to investigate the potential effects of traditional risk factors such as age, gender, and obesity on these outcomes.
Material and Methods: A total of 51 patients who underwent a POEM procedure were retrospectively evaluated from January 2021 to July 2023. The main outcome measured was the rate of clinical success, determined by achieving an Eckardt score of 3 or lower two months after the procedure. Secondary outcomes involved any adverse events, ICU admissions, and the presence of reflux symptoms at the two-month post-procedure mark.
Results: The mean age of the patients was 49.3 ± 13.3 years, and the duration of symptoms ranged between 6 months and 10 years. Preoperative median Eckardt scores were 9, ranging between 5 and 12. At the 2nd month post-procedure, 96.1% of patients had an Eckardt score of 3 or lower, with a median reduction of 8 points (IQR = 6 – 8, p < 0.001). Among the patients, 13.7% encountered adverse events, comprising 3.9% with pneumomediastinum, 1.9% with mediastinitis, and 1.9% with intra-tunnel bleeding. At the 2nd month post-procedure, 17.6% of patients exhibited reflux esophagitis. No mortality was observed in any of the patients.
Conclusion: POEM is an effective, safe, and minimally invasive treatment for achalasia that represents a promising therapeutic option, offering symptomatic relief, improved quality of life, and boasting a high clinical success rate. Although a small percentage of patients experienced adverse events, these were manageable and did not result in mortality.

Keywords

Achalasia, endoscopy, per-oral endoscopic myotomy, myotom

Ethical Statement

The study was performed in accordance with the Declaration of Helsinki, and was approved by the Umraniye Training and Research Hospital Clinical Research Ethics Committee (Date: 10.08.2023, Decision No: 292).

Project Number

292

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