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.

• Authors: Saurabh Chandan, Babu Pappu Mohan, Ojasvini Choudhry Chandan, Lokesh Kumar Jha, Harmeet Singh Mashiana, Alexander Todd Hewlett, Mouen A Khashab
• Journal: Surgical endoscopy (Surg Endosc) Vol. 34 Issue 2 Pg. 707-718 (02 2020) ISSN: 1432-2218 [Electronic] Germany
• PMID: 31073769 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review)

Topics

• Esophageal Achalasia (surgery)
• Esophageal Motility Disorders (surgery)
• Esophageal Spasm, Diffuse (surgery)
• Esophagoscopy (adverse effects, methods)
• Humans
• Myotomy (adverse effects, methods)
• Natural Orifice Endoscopic Surgery (adverse effects, methods)
• Treatment Outcome