Shali Tan1, Chunyu Zhong1, Yutang Ren2, Xujuan Luo1, Jin Xu1, Xiangsheng Fu3, Yan Peng1, Xiaowei Tang1. 1. Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China. 2. Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, Tsinghua University School of Clinical Medicine, Beijing, China. 3. Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Abstract
Background/Aims: Peroral endoscopic myotomy (POEM) has emerged as a rescue treatment for recurrent or persistent achalasia after failed initial management. Therefore, we aimed to investigate the efficacy and safety of POEM in achalasia patients with failed previous intervention. Methods: We searched the MEDLINE, Embase, Cochrane, and PubMed databases using the queries "achalasia," "peroral endoscopic myotomy," and related terms in March 2019. Data on technical and clinical success, adverse events, Eckardt score and lower esophageal sphincter (LES) pressure were collected. The pooled event rates, mean differences (MDs) and risk ratios (RR) were calculated. Results: A total of 15 studies with 2,276 achalasia patients were included. Overall, the pooled technical success, clinical success and adverse events rate of rescue POEM were 98.0% (95% confidence interval [CI], 96.6% to 98.8%), 90.8% (95% CI, 88.8% to 92.4%) and 10.3% (95% CI, 6.6% to 15.8%), respectively. Seven studies compared the clinical outcomes of POEM between previous failed treatment and the treatment naïve patients. The RR for technical success, clinical success, and adverse events were 1.00 (95% CI, 0.98 to 1.01), 0.98 (95% CI, 0.92 to 1.04), and 1.17 (95% CI, 0.78 to 1.76), respectively. Overall, there was significant reduction in the pre- and post-Eckardt score (MD, 5.77; p<0.001) and LES pressure (MD, 18.3 mm Hg; p<0.001) for achalasia patients with failed previous intervention after POEM. Conclusions: POEM appears to be a safe, effective and feasible treatment for individuals who have undergone previous failed intervention. It has similar outcomes in previously treated and treatment-naïve achalasia patients.
Background/Aims: Peroral endoscopic myotomy (POEM) has emerged as a rescue treatment for recurrent or persistent achalasia after failed initial management. Therefore, we aimed to investigate the efficacy and safety of POEM in achalasiapatients with failed previous intervention. Methods: We searched the MEDLINE, Embase, Cochrane, and PubMed databases using the queries "achalasia," "peroral endoscopic myotomy," and related terms in March 2019. Data on technical and clinical success, adverse events, Eckardt score and lower esophageal sphincter (LES) pressure were collected. The pooled event rates, mean differences (MDs) and risk ratios (RR) were calculated. Results: A total of 15 studies with 2,276 achalasiapatients were included. Overall, the pooled technical success, clinical success and adverse events rate of rescue POEM were 98.0% (95% confidence interval [CI], 96.6% to 98.8%), 90.8% (95% CI, 88.8% to 92.4%) and 10.3% (95% CI, 6.6% to 15.8%), respectively. Seven studies compared the clinical outcomes of POEM between previous failed treatment and the treatment naïve patients. The RR for technical success, clinical success, and adverse events were 1.00 (95% CI, 0.98 to 1.01), 0.98 (95% CI, 0.92 to 1.04), and 1.17 (95% CI, 0.78 to 1.76), respectively. Overall, there was significant reduction in the pre- and post-Eckardt score (MD, 5.77; p<0.001) and LES pressure (MD, 18.3 mm Hg; p<0.001) for achalasiapatients with failed previous intervention after POEM. Conclusions: POEM appears to be a safe, effective and feasible treatment for individuals who have undergone previous failed intervention. It has similar outcomes in previously treated and treatment-naïve achalasiapatients.
Authors: Dagmar Simkova; Jan Mares; Zuzana Vackova; Tomas Hucl; Petr Stirand; Eva Kieslichova; Ondrej Ryska; Julius Spicak; Sylvia Drazilova; Eduard Veseliny; Jan Martinek Journal: Surg Endosc Date: 2022-09-28 Impact factor: 3.453