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Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis

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Abstract

Background

Peroral endoscopic myotomy (POEM) is an evolving therapeutic modality for achalasia. We aim to determine efficacy of POEM for the treatment of achalasia and compare it with laparoscopic Heller’s myotomy (LHM).

Materials and methods

Systematic review and meta-analyses was conducted on 19 studies using POEM for achalasia. Pubmed, Medline, Cochrane, and Ovid databases, were searched using the terms ‘achalasia’, ‘POEM’, ‘peroral endoscopic myotomy’, ‘per oral endoscopic myotomy’, and ‘per-oral endoscopic myotomy’. Reduction in Eckhart’s score and lower esophageal sphincter (LES) pressure were the main outcome measures.

Results

A total of 1,045 patients underwent POEM in 29 studies. Ninety patients undergoing POEM was compared with 160 undergoing LHM in five studies. Nineteen and 14 studies, respectively, evaluated for Eckhart’s score and LES pressure. There was significant reduction in Eckhart’s score and LES pressure with effect sizes of −7.95 (p < 0.0001) and −7.28 (p < 0.0001), respectively. There was significant heterogeneity among the studies [(Q = 83.06; I 2 = 78.33 %; p < 0.0001) for Eckhart’s score and (Q = 61.44; I 2 = 75.68 %; p < 0.0001) for LES pressure]. There were no differences between POEM and LHM in reduction in Eckhart’s score, post-operative pain scores and analgesic requirements, length of hospital stay, adverse events, and symptomatic gastroesophageal reflux/reflux esophagitis. Operative time was significantly lower for POEM.

Conclusions

POEM is effective for achalasia and has similar outcomes as LHM. Multicenter randomized trials need to be conducted to further compare the efficacy and safety of POEM between treatment naïve achalasia patients and those who failed treatment.

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Abbreviations

POEM:

Peroral endoscopic myotomy

LHM:

Laparoscopic Heller’s myotomy

LES:

Lower esophageal sphincter

NOTES:

Natural orifice transmural endoscopic surgery

USA:

United States of America

CI:

Confidence interval

SD:

Standard deviation

GER/RE:

Gastroesophageal reflux/reflux esophagitis

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Disclosures

Drs. Rupjyoti Talukdar and D. Nageshwar Reddy have no conflicts of interest or financial ties to disclose. Dr. Haruhiro Inoue is an advisor to Olympus.

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Authors and Affiliations

  1. Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500082, India

    Rupjyoti Talukdar & D. Nageshwar Reddy

  2. Asian Healthcare Foundation, Hyderabad, India

    Rupjyoti Talukdar

  3. Digestive Disease Center, Showa University, Yokohama, Japan

    Haruhiro Inoue

Authors
  1. Rupjyoti Talukdar
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  3. D. Nageshwar Reddy
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Correspondence to Rupjyoti Talukdar.

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Talukdar, R., Inoue, H. & Reddy, D.N. Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis. Surg Endosc 29, 3030–3046 (2015). https://doi.org/10.1007/s00464-014-4040-6

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