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Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis.
Dis Esophagus. 2016 Oct; 29(7):807-819.DE

Abstract

Peroral endoscopic myotomy (POEM) is a novel approach to performing esophageal myotomy for the treatment of achalasia. This review aims to assess subjective and objective metrics of achalasia treatment efficacy, perioperative adverse events and the incidence of postoperative gastroesophageal reflux disease in patients treated with POEM. Secondary aims include a pooled analysis comparison of the clinical outcomes and procedural safety of POEM versus laparoscopic Heller's myotomy (LHM). A systematic review of the literature, up to and including January 15, 2015, was conducted for studies reporting POEM outcomes. Studies comparing POEM to LHM were also included for the purpose of pooled analysis. Outcomes from 1122 POEM patients, from 22 studies, are reported in this systematic review. Minor operative adverse events included capno/pneumo-peritoneum (30.6%), capno/pneumo-thorax (11.0%) and subcutaneous emphysema (31.6%). Major operative adverse events included mediastinal leak (0.3%), postoperative bleeding (1.1%) and a single mortality (0.09%). There was an improvement in lower esophageal sphincter pressure and timed barium esophagram column height of 66% and 80% post-POEM, respectively. Symptom improvement was demonstrated with a pre- and post-POEM Eckardt score ± standard deviation of 6.8 ± 1.0 and 1.2 ± 0.6, respectively. Pre- and post-POEM endoscopy showed esophagitis in 0% and 19% of patients, respectively. The median (interquartile range) points scored for study quality was 15 (14-16) out of total of 32. Pooled analysis of three comparative studies between LHM and POEM showed similar results for adverse events, perforation rate, operative time and a nonsignificant trend toward a reduced length of hospital stay in the POEM group. In conclusion, POEM is a safe and effective treatment for achalasia, showing significant improvements in objective metrics and achalasia-related symptoms. Randomized comparative studies of LHM and POEM are required to determine the most effective treatment modality for achalasia.

Authors+Show Affiliations

Department of Upper Gastro-Intestinal Surgery, East Surrey Hospital, Redhill, UK.Department of Surgery and Cancer, Imperial College London, London, UK.Department of Surgery and Cancer, Imperial College London, London, UK.Department of Surgery and Cancer, Imperial College London, London, UK.Department of Upper Gastro-Intestinal Surgery, East Surrey Hospital, Redhill, UK.Department of Surgery and Cancer, Imperial College London, London, UK. g.zaninotto@imperial.ac.uk.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

26175119

Citation

Patel, K, et al. "Peroral Endoscopic Myotomy for the Treatment of Esophageal Achalasia: Systematic Review and Pooled Analysis." Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus, vol. 29, no. 7, 2016, pp. 807-819.
Patel K, Abbassi-Ghadi N, Markar S, et al. Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis. Dis Esophagus. 2016;29(7):807-819.
Patel, K., Abbassi-Ghadi, N., Markar, S., Kumar, S., Jethwa, P., & Zaninotto, G. (2016). Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis. Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus, 29(7), 807-819. https://doi.org/10.1111/dote.12387
Patel K, et al. Peroral Endoscopic Myotomy for the Treatment of Esophageal Achalasia: Systematic Review and Pooled Analysis. Dis Esophagus. 2016;29(7):807-819. PubMed PMID: 26175119.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis. AU - Patel,K, AU - Abbassi-Ghadi,N, AU - Markar,S, AU - Kumar,S, AU - Jethwa,P, AU - Zaninotto,G, Y1 - 2015/07/14/ PY - 2015/7/16/pubmed PY - 2017/2/2/medline PY - 2015/7/16/entrez KW - Heller's myotomy KW - POEM KW - achalasia KW - myotomy SP - 807 EP - 819 JF - Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus JO - Dis. Esophagus VL - 29 IS - 7 N2 - Peroral endoscopic myotomy (POEM) is a novel approach to performing esophageal myotomy for the treatment of achalasia. This review aims to assess subjective and objective metrics of achalasia treatment efficacy, perioperative adverse events and the incidence of postoperative gastroesophageal reflux disease in patients treated with POEM. Secondary aims include a pooled analysis comparison of the clinical outcomes and procedural safety of POEM versus laparoscopic Heller's myotomy (LHM). A systematic review of the literature, up to and including January 15, 2015, was conducted for studies reporting POEM outcomes. Studies comparing POEM to LHM were also included for the purpose of pooled analysis. Outcomes from 1122 POEM patients, from 22 studies, are reported in this systematic review. Minor operative adverse events included capno/pneumo-peritoneum (30.6%), capno/pneumo-thorax (11.0%) and subcutaneous emphysema (31.6%). Major operative adverse events included mediastinal leak (0.3%), postoperative bleeding (1.1%) and a single mortality (0.09%). There was an improvement in lower esophageal sphincter pressure and timed barium esophagram column height of 66% and 80% post-POEM, respectively. Symptom improvement was demonstrated with a pre- and post-POEM Eckardt score ± standard deviation of 6.8 ± 1.0 and 1.2 ± 0.6, respectively. Pre- and post-POEM endoscopy showed esophagitis in 0% and 19% of patients, respectively. The median (interquartile range) points scored for study quality was 15 (14-16) out of total of 32. Pooled analysis of three comparative studies between LHM and POEM showed similar results for adverse events, perforation rate, operative time and a nonsignificant trend toward a reduced length of hospital stay in the POEM group. In conclusion, POEM is a safe and effective treatment for achalasia, showing significant improvements in objective metrics and achalasia-related symptoms. Randomized comparative studies of LHM and POEM are required to determine the most effective treatment modality for achalasia. SN - 1442-2050 UR - https://www.unboundmedicine.com/medline/citation/26175119/Peroral_endoscopic_myotomy_for_the_treatment_of_esophageal_achalasia:_systematic_review_and_pooled_analysis_ L2 - https://academic.oup.com/dote/article-lookup/doi/10.1111/dote.12387 DB - PRIME DP - Unbound Medicine ER -