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Endoscopy 2023; 55(02): 167-175
DOI: 10.1055/a-1894-0147
Systematic review

Long-term outcomes of peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis

Edoardo Vespa  ‡   *
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
Gaia Pellegatta‡   *
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Viveksandeep T. Chandrasekar 
3   Department of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, United States
,
Marco Spadaccini
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
Harsh Patel
4   Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana, United States
,
Roberta Maselli
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
Piera A. Galtieri
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Elisa Carlani
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Prateek Sharma
5   Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, United States
,
Cesare Hassan
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
Alessandro Repici
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Comments on: “Long-term outcomes of peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis”Endoscopy 2023; 55(03): 297-297
DOI: 10.1055/a-1929-1522

Abstract

Background The long-term outcomes of esophageal peroral endoscopic myotomy (POEM) are still unknown.

Methods We searched electronic databases (MEDLINE/PubMed, EMBASE, Scopus) for studies assessing outcomes after POEM for esophageal achalasia with a minimum median follow-up duration of 36 months. Pooled rates of clinical success and postoperative reflux were calculated and compared with the same values at 12/24/36 months when available. Subgroup analyses were performed to explore the interstudy heterogeneity.

Results From 1528 initial records, 11 studies (2017–2021) were included. A total of 2342 patients (age 48.1 [SD 6.8] years; 50.1 % males) with a median follow-up of 48 months (interquartile range 45–60) were analyzed. The pooled clinical success rate was 87.3 % (95 %CI 83.6 %–91.0 %; I2  = 73.1 %). The symptomatic reflux pooled rate was 22.0 % (95 %CI 14.4 %–29.5 %; I2  = 92.7 %). Three cases of peptic strictures and one Barrett’s esophagus were reported. The pooled rate of severe adverse events was 1.5 % (95 %CI 0.5 %–2.5 %; I2  = 52.8 %).

Conclusions Long-term clinical efficacy of POEM persisted in 87 % of patients with achalasia. Post-POEM symptomatic reflux remained stable over time. The risk for Barrett’s esophagus and peptic strictures appeared minimal.

* Co-first authors.


Tables 1 s–3 s, Figs. 1 s–10 s



Publication History

Received: 28 November 2021

Accepted after revision: 07 July 2022

Accepted Manuscript online:
07 July 2022

Article published online:
31 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Inoue H, Minami H, Kobayashi Y. et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42: 265-271
    Google Scholar
  • 2 Barbieri LA, Hassan C, Rosati R. et al. Systematic review and meta-analysis: efficacy and safety of POEM for achalasia. United Eur Gastroenterol J 2015; 3: 325-334
    CrossrefPubMedGoogle Scholar
  • 3 Werner YB, Costamagna G, Swanström LL. et al. Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years. Gut 2016; 65: 899-906
    CrossrefPubMedGoogle Scholar
  • 4 Martinek J, Svecova H, Vackova Z. et al. Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety. Surg Endosc 2018; 32: 1293-1302
    CrossrefPubMedGoogle Scholar
  • 5 Liu X, Yao L, Cheng J. et al. Landscape of adverse events related to peroral endoscopic myotomy in 3135 patients and a risk-scoring system to predict major adverse events. Clin Gastroenterol Hepatol 2021; 19: 1959-1966
    CrossrefPubMedGoogle Scholar
  • 6 Repici A, Fuccio L, Maselli R. et al. GERD after per-oral endoscopic myotomy as compared with Heller’s myotomy with fundoplication: a systematic review with meta-analysis. Gastrointest Endosc 2018; 87: 934-943
    Google Scholar
  • 7 Nabi Z, Ramchandani M, Kotla R. et al. Gastroesophageal reflux disease after peroral endoscopic myotomy is unpredictable, but responsive to proton pump inhibitor therapy: a large, single-center study. Endoscopy 2020; 52: 643-651
    Google Scholar
  • 8 Oude Nijhuis RAB, Zaninotto G, Roman S. et al. European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations. United Eur Gastroenterol J 2020; 8: 13-33
    CrossrefPubMedGoogle Scholar
  • 9 Werner YB, Hakanson B, Martinek J. et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med 2019; 381: 2219-2229
    Google Scholar
  • 10 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
    Google Scholar
  • 11 Guo H, Yang H, Zhang X. et al. Long-term outcomes of peroral endoscopic myotomy for patients with achalasia: a retrospective single-center study. Dis Esophagus 2017; 30: 1-6
    CrossrefPubMedGoogle Scholar
  • 12 Brewer Gutierrez OI, Moran RA, Familiari P. et al. Long-term outcomes of per-oral endoscopic myotomy in achalasia patients with a minimum follow-up of 4 years: a multicenter study. Endosc Int open 2020; 8: E650-E655
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Podboy AJ, Hwang JH, Rivas H. et al. Long-term outcomes of per-oral endoscopic myotomy compared to laparoscopic Heller myotomy for achalasia: a single-center experience. Surg Endosc 2021; 35: 792-801
    CrossrefPubMedGoogle Scholar
  • 14 He C, Li M, Lu B. et al. Long-term efficacy of peroral endoscopic myotomy for patients with achalasia: outcomes with a median follow-up of 36 months. Dig Dis Sci 2019; 64: 803-810
    CrossrefPubMedGoogle Scholar
  • 15 Liu X-Y, Cheng J, Chen W-F. et al. A risk-scoring system to predict clinical failure for patients with achalasia after peroral endoscopic myotomy. Gastrointest Endosc 2020; 91: 33-40
    CrossrefPubMedGoogle Scholar
  • 16 McKay SC, Dunst CM, Sharata AM. et al. POEM: clinical outcomes beyond 5 years. Surg Endosc 2021; 35: 5709-5716
    CrossrefPubMedGoogle Scholar
  • 17 Hernández Mondragón OV, González Martinez MA, Blancas Valencia JM. et al. Long-term quality of life after peroral endoscopic myotomy remains compromised in patients with achalasia type III. Endoscopy 2017; 49: 1209-1218
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Nabi Z, Chavan R, Ramchandani M. et al. Long-term outcomes of per-oral endoscopic myotomy in spastic esophageal motility disorders: a large, single-center study. J Clin Gastroenterol 2021; 55: 594-601
    CrossrefPubMedGoogle Scholar
  • 19 Teitelbaum EN, Dunst CM, Reavis KM. et al. Clinical outcomes five years after POEM for treatment of primary esophageal motility disorders. Surg Endosc 2018; 32: 421-427
    CrossrefPubMedGoogle Scholar
  • 20 Campagna RAJ, Cirera A, Holmstrom AL. et al. Outcomes of 100 patients more than 4 years after poem for achalasia. Ann Surg 2021; 273: 1135-1140
    CrossrefPubMedGoogle Scholar
  • 21 Zhang W-G, Chai N-L, Zhai Y-Q. et al. Long-term outcomes of peroral endoscopic myotomy in achalasia patients with a minimum follow-up of 7 years. Chin Med J (Engl) 2020; 133: 996-998
    CrossrefPubMedGoogle Scholar
  • 22 Weber CE, Davis CS, Kramer HJ. et al. Medium and long-term outcomes after pneumatic dilation or laparoscopic Heller myotomy for achalasia: a meta-analysis. Surg Laparosc Endosc Percutan Tech 2012; 22: 289-296
    CrossrefPubMedGoogle Scholar
  • 23 Moonen A, Annese V, Belmans A. et al. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut 2016; 65: 732-739
    Google Scholar
  • 24 Schlottmann F, Luckett DJ, Fine J. et al. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. Ann Surg 2018; 267: 451-460
    CrossrefPubMedGoogle Scholar
  • 25 Ramchandani M, Nageshwar Reddy D, Nabi Z. et al. Management of achalasia cardia: expert consensus statements. J Gastroenterol Hepatol 2018; 33: 1436-1444
    CrossrefPubMedGoogle Scholar
  • 26 Ofosu A, Mohan BP, Ichkhanian Y. et al. Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: a meta-analysis of studies with ≥12-month follow-up. Endosc Int Open 2021; 9: E1097-E1107
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Ponds FA, Oors JM, Smout AJPM. et al. Reflux symptoms and oesophageal acidification in treated achalasia patients are often not reflux related. Gut 2021; 70: 30-39
    CrossrefPubMedGoogle Scholar