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

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.

Author information

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) doi:10.1007/s00464-019-06819-6

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Keywords

  • Diffuse esophageal spasm
  • Nutcracker esophagus
  • Achalasia
  • Esophageal motility