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Clinical efficacy of per-oral endoscopic myotomy (POEM) for spastic esophageal disorders: a systematic review and meta-analysis

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Abstract

Background

POEM has been successfully performed in patients with spastic esophageal disorders (SED), such as diffuse esophageal spasm, jackhammer esophagus, and type 3 achalasia. We performed a systematic review and meta-analysis to evaluate its efficacy in these patients and if total average myotomy length and prior medical or endoscopic treatments affected clinical success.

Methods

PubMed, EMBASE, Google-Scholar, Scopus, and Cochrane Review were searched for studies on POEM in SED from 2008 to September 2018. Clinical success was determined by Eckardt score (≤ 3) at follow-up. Sub-group analysis was performed based on myotomy length and evaluates the effect of prior treatments on clinical success.

Results

9 studies with 210 patients were included in the final analysis. We found that the pooled rate of clinical success for POEM was 89.6% (95% CI 83.5–93.1, 95% PI 83.4–93.7, I2 = 0%). In three studies (50 patients), where total myotomy length was < 10 cm, the pooled rate of clinical success was 91.1% (95% CI 79.5–96.4, I2 = 0%). In six studies (160 patients), the length was > 10 cms and the pooled rate of clinical success was 89.1% (95% CI 83.0–93.2, I2 = 0%). The difference between these results was not statistically significant (p = 0.69). Additionally, a meta-regression analysis showed that prior treatment status did not significantly affect the primary outcome (p = 0.43).

Conclusions

While it is well known that POEM is a safe and effective treatment for spastic esophageal disorders, we conclude that variation in total myotomy length and prior endoscopic or medical treatments did not have a significant effect on clinical success.

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Acknowledgements

The authors would like to thank Emily Glenn, MLS, McGoogan Library of Medicine, University of Nebraska Medical Center who assisted in the literature search.

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Authors and Affiliations

  1. Department of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198, USA

    Saurabh Chandan, Lokesh Kumar Jha, Harmeet Singh Mashiana & Alexander Todd Hewlett

  2. Department of Internal Medicine, Banner University Medical Center, Tucson, AZ, USA

    Babu Pappu Mohan

  3. Department of Pediatric Gastroenterology, Hepatology & Nutrition, University of Nebraska Medical Center, Omaha, NE, USA

    Ojasvini Choudhry Chandan

  4. Division of Gastroenterology & Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA

    Mouen A. Khashab

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  1. Saurabh Chandan
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Correspondence to Saurabh Chandan.

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Disclosures

This study was not supported by any funding or grants. This study will, in part, be presented as a Lecture Presentation at Digestive Disease Week (DDW) 2019. Mouen Khashab is a consultant and on the medical advisory board for Boston Scientific and Olympus. He is also a consultant for Medtronic. Dr(s). Chandan, Choudhry Chandan, Jha, Mashiana and Hewlett All other authors have no conflict of interest or financial ties to disclose.

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Chandan, S., Mohan, B.P., Chandan, O.C. et al. Clinical efficacy of per-oral endoscopic myotomy (POEM) for spastic esophageal disorders: a systematic review and meta-analysis. Surg Endosc 34, 707–718 (2020). https://doi.org/10.1007/s00464-019-06819-6

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  • DOI: https://doi.org/10.1007/s00464-019-06819-6

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