食道アカラジアに対するPOEMの評価：ＮＥＪＭ

 この10年日本が世界の医療に貢献した治療薬あるいは治療技術として、文句なしに誇れるものの一つは食道アカラジアに対する内視鏡食道内輪筋切開術治療POEMの開発であろう。昭和大学の井上　晴洋教授（昭和大学横浜市北部病院）や塩飽　洋生（福岡大学）、南ひとみ医師（長崎大学）らの努力と時宜を得た報告には温かい拍手をお送りしたいと思います。

Gastoroenterologyに最新のアカラジア治療ガイドが出ておりそこでは全米消化器学会の推奨としてPOEM治療が挙げられている。これを受けて最近のNEJMにコメントが載っている。

 

Clinical Practice Update: The Use of Per-Oral Endoscopic Myotomy in Achalasia: Expert Review and Best Practice Advice From the AGA Institute

Peter J. Kahrilas Peter J. KahrilasDavid Katzka,Joel E. Richter

Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois

The purpose of this review is to describe a place for per-oral endoscopic myotomy (POEM) among the currently available robust treatments for achalasia.
The recommendations outlined in this review are based on expert opinion and on relevant publications from PubMed and EMbase. The Clinical Practice Updates Committee of the American Gastroenterological Association proposes the following recommendations: 1) in determining the need for achalasia therapy, patient-specific parameters (Chicago Classification subtype, comorbidities, early vs late disease, primary or secondary causes) should be considered along with published efficacy data; 2) given the complexity of this procedure, POEM should be performed by experienced physicians in high-volume centers because an estimated 20−40 procedures are needed to achieve competence; 3) if the expertise is available, POEM should be considered as primary therapy for type III achalasia; 4) if the expertise is available, POEM should be considered as treatment option comparable with laparoscopic Heller myotomy for any of the achalasia syndromes; and 5) post-POEM patients should be considered high risk to develop reflux esophagitis and advised of the management considerations (potential indefinite proton pump inhibitor therapy and/or surveillance endoscopy) of this before undergoing the procedure.