scholarly journals Clinical outcomes of peroral endoscopic myotomy for achalasia in children: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Chunyu Zhong ◽  
Shali Tan ◽  
Shu Huang ◽  
Yan Peng ◽  
Muhan Lü ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Success ◽  
Meta Analysis ◽  
Final Analysis ◽  
Lower Esophageal Sphincter Pressure ◽  
Peroral Endoscopic Myotomy ◽  
Sphincter Pressure ◽  
Eckardt Score ◽  
Effective Treatment Modality ◽  
Endoscopic Myotomy

Abstract Peroral endoscopic myotomy (POEM) is a novel minimally invasive intervention, which has shown to be effective and safe for treating achalasia in adults. Presently, POEM was also reported to be effective for achalasia in children. So we conducted this study to explore the clinical outcomes of POEM for pediatric achalasia. A systematic literature search in PubMed, Embase, and Cochrane databases was performed, which covered the period from January 2009 to June 2020. Selecting studies and collecting data was independently by two reviewers according to predefined criteria. The statistical analysis was carried out using Comprehensive Meta-Analysis software version 2 and Review Manager 5.3. A total of 11 studies with 389 children were identified in the final analysis. Pooled technical success of POEM treatment achalasia was achieved in 385 children (97.4%; 95% confidence interval [CI], 94.7%–98.7%), and the pooled clinical success was achieved in 348 children (92.4%; 95% CI, 89.0%–94.8%). After POEM, the Eckardt score was significantly decreased by 6.76 points (95% CI, 6.18–7.34, P < 0.00001), and the lower esophageal sphincter pressure was significantly reduced by 19.38 mmHg (95% CI, 17.54–21.22, P < 0.00001). The pooled major adverse events rate related to POEM was 12.8% (95% CI, 4.5%–31.5%) and the gastroesophageal reflux rate was 17.8% (95% CI, 14.2%–22.0%). Our current study demonstrated that the POEM was an effective and safe technique for treating achalasia in children. Further randomized comparative studies of POEM and other therapeutic methods are warranted to determine the most effective treatment modality for achalasia in children.

scholarly journals Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

2021 ◽  
Vol 09 (07) ◽  
pp. E1097-E1107
Author(s):  
Andrew Ofosu ◽  
Babu P. Mohan ◽  
Yervant Ichkhanian ◽  
Maen Masadeh ◽  
John Febin ◽  
...  
Keyword(s):  
Clinical Success ◽  
Meta Analysis ◽  
Balloon Dilation ◽  
Final Analysis ◽  
Peroral Endoscopic Myotomy ◽  
Pneumatic Dilation ◽  
Type I ◽  
Eckardt Score ◽  
Endoscopic Myotomy

Abstract Background and study aims Peroral endoscopic myotomy (POEM) is increasingly being used as the preferred treatment option for achalasia. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of POEM versus pneumatic balloon dilation (PD). Methods We performed a comprehensive review of studies that reported clinical outcomes of POEM and PD for the treatment of achalasia. Measured outcomes included clinical success (improvement of symptoms based on a validated scale including an Eckardt score ≤ 3), adverse events, and post-treatment gastroesophageal reflux disease (GERD). Results Sixty-six studies (6268 patients) were included in the final analysis, of which 29 studies (2919 patients) reported on POEM and 33 studies (3050 patients) reported on PD and 4 studies (299 patients) compared POEM versus PD. Clinical success with POEM was superior to PD at 12, 24, and 36 months (92.9 %, vs 76.9 % P = 0.001; 90.6 % vs 74.8 %, P = 0.004; 88.4 % vs 72.2 %, P = 0.006, respectively). POEM was superior to PD in type I, II and III achalasia (92.7 % vs 61 %, P = 0.01; 92.3 % vs 80.3 %, P = 0.01; 92.3 %v 41.9 %, P = 0.01 respectively)Pooled OR of clinical success at 12 and 24 months were significantly higher with POEM (8.97; P = 0.001 & 5.64; P = 0.006). Pooled OR of GERD was significantly higher with POEM (by symptoms: 2.95, P = 0.02 and by endoscopic findings: 6.98, P = 0.001). Rates of esophageal perforation (0.3 % vs 0.6 %, P = 0.8) and significant bleeding (0.4 % vs 0.7 %, P = 0.56) were comparable between POEM and PD groups. Conclusions POEM is more efficacious than PD in the treatment of patients with achalasia during short-term and long-term follow-up, albeit with higher risk of abnormal esophageal acid exposure.

The Effect of Peroral Endoscopic Myotomy in Achalasia Patients with Prior Endoscopic Intervention: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-13
Author(s):  
Chunyu Zhong ◽  
Bowen Ni ◽  
Sixiu Liu ◽  
Shali Tan ◽  
Muhan Lü ◽  
...  
Keyword(s):  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Clinical Success ◽  
Meta Analysis ◽  
Clinical Success Rate ◽  
Peroral Endoscopic Myotomy ◽  
Technical Success ◽  
Endoscopic Intervention ◽  
Eckardt Score ◽  
Endoscopic Myotomy

<b><i>Background:</i></b> Peroral endoscopic myotomy (POEM) has been reported to be effective in achalasia patients with prior failed endoscopic intervention (PFI). We performed this meta-analysis to compare and summarize the clinical outcome of POEM in patients with or without prior endoscopic intervention. <b><i>Method:</i></b> We searched relevant studies published up to March 2020. Meta-analysis for technical success, clinical success, Eckardt score, lower esophageal sphincter (LES) pressure, clinical reflux, and adverse event were conducted based on a random-effects model. <b><i>Results:</i></b> Eight studies enrolling 1,797 patients who underwent POEM were enrolled, including 1,128 naïve achalasia patients and 669 patients with PFI. In the PFI group, the pooled estimated rate of technical success was 97.7% (95% confidence interval [CI], 95.8–98.8%), the pooled clinical success rate was 91.0% (95% CI, 88.0–93.4%), and the pooled adverse events rate was 23.5% (95% CI, 10.6–44.1%). The Eckardt score significantly decreased by 5.95 points (95% CI, 5.50–6.40, <i>p</i> &#x3c; 0.00001) and the LES pressure significantly reduced by 19.74 mm Hg (95% CI, 14.10–25.39, <i>p</i> &#x3c; 0.00001) in the PFI group. There were no difference in the technical success, clinical success, and adverse events rate between the treatment-naïve group and PFI group, with a risk ratio of 1.0 (95% CI, 0.99–1.01, <i>p</i> = 0.89), 1.02 (95% CI, 0.98–1.06, <i>p</i> = 0.36), and 0.88 (95% CI, 0.67–1.16, <i>p</i> = 0.38), respectively. <b><i>Conclusions:</i></b> POEM is an effective and safe treatment for achalasia patients with prior endoscopic intervention. Randomized clinical trials are needed to further verify the efficiency and safety of the POEM in those patients.

scholarly journals Role of peroral endoscopic myotomy in geriatric patients with achalasia: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Chunyu Zhong ◽  
Sixiu Liu ◽  
Huifang Xia ◽  
Shali Tan ◽  
Muhan Lü ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Geriatric Patients ◽  
Clinical Success ◽  
Meta Analysis ◽  
Peroral Endoscopic Myotomy ◽  
Cochrane Library ◽  
Eckardt Score ◽  
Endoscopic Myotomy

Background: Peroral endoscopic myotomy (POEM) is a particularly attractive intervention for achalasia. Presently, POEM has been reported to be effective and safe for achalasia in geriatric patients. Herein, this systematic review was conducted to explore the role of POEM in geriatric patients with achalasia. Method: PubMed, Embase and Cochrane Library were searched to identify studies evaluating the clinical outcome of POEM in geriatric patients with achalasia during January 2009 to October 2020. The primary outcomes were technical and clinical success. Secondary outcomes included postoperative Eckardt score, lower esophageal sphincter (LES) pressure, adverse events and clinical reflux. Results: There were seven studies with a total of 469 geriatric patients, pooled technical success of POEM treatment was 98.1% [95% confidence interval (CI), 95.1%-99.3%], and the pooled clinical success was 92.5% (95% CI, 89.3%-94.8%). After POEM, the Eckardt score significantly decreased by 6.09 points (95% CI, 5.44-6.74, P<0.00001), and the LES pressure significantly reduced by 13.53 mmHg (95% CI, 5.14-21.91, P=0.002). The pooled adverse events rate was 9.0% (95% CI, 4.3%-17.9%) and the post-POEM clinical reflux rate was 17.4% (95% CI, 12.9%-23.2%). Conclusions: Our current study demonstrated that POEM was an effective and safe technique for achalasia in geriatric patients.

Effects of Peroral Endoscopic Myotomy on Esophageal Function in the Treatment of Achalasia

2020 ◽  
pp. 155335062091313
Author(s):  
Bai Cang Zou ◽  
Li Zhang ◽  
Bin Qin ◽  
Shen Hao Wang ◽  
Yan Cheng ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Clinical Symptoms ◽  
Operation Time ◽  
Peroral Endoscopic Myotomy ◽  
Esophageal Stent ◽  
Sphincter Pressure ◽  
Esophageal Function ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Peroral endoscopic myotomy (POEM) is a new technique to treat achalasia, but the effects on esophageal motor function and structure are still unclear. This study aimed to examine the esophageal function and anatomical changes of patients with achalasia treated with POEM. This was a retrospective study of 43 patients with achalasia treated with POEM between January 2013 and January 2016 at the Second Affiliated Hospital of Xi’an Jiaotong University. The patients were grouped as previous treatments for achalasia (n = 19) versus no previous treatment (n = 24). Surgical success (defined as Eckardt score ≤3 points or decreased by >3 points compared with baseline), recurrence, and reintervention were analyzed. Three patients (7.0%) were Eckardt grade I, 16 (37.2%) were grade II, and 24 (55.8%) were grade III. Operation time was 35 to 150 (median = 49) minutes. Both groups showed improvements in the Eckardt score after surgery (both P < .001), without a difference between the 2 groups ( P = .749). The maximal mean diameter of the esophagus was reduced, and the lower esophageal sphincter pressure was improved after surgery (both groups, all P < .001), without difference between the 2 groups (all P > .05). One case of failure was probably due to the presence of an esophageal stent. POEM has a high success rate and is possibly unaffected by previous treatments, except maybe stent implantation. Clinical symptoms of achalasia are significantly relieved by POEM; the function of the esophageal sphincter and the esophagus structure are improved. Previous esophageal stent implantation could increase failure likelihood, but this will have to be confirmed.

A Meta-Analysis and Systematic Review of Prospective Trials: Eckardt Score with Peroral Endoscopic Myotomy (POEM) Versus Surgical Myotomy in Managing Adult Achalasia Patients

2017 ◽  
Vol 152 (5) ◽  
pp. S1264-S1265
Author(s):  
Abhiram Duvvuri ◽  
Vishnu Moole ◽  
Anwesh Poosala ◽  
Raghuveer R. Boddireddy ◽  
Achuta Uppu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Peroral Endoscopic Myotomy ◽  
Eckardt Score ◽  
Prospective Trials ◽  
Endoscopic Myotomy

P27 PERORAL ENDOSCOPIC MYOTOMY (POEM) FOR TREATMENT OF ACHALASIA. CLINICAL OUTCOMES OF A SINGLE-CENTER INSTITUTE IN UK

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Gavriella Zoi Vrakopoulou ◽  
Lavinia Barbieri ◽  
Andrei Ilczyszyn ◽  
Karim Hamaoui ◽  
Nikolaos Memos ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Success ◽  
Demographic Data ◽  
High Resolution Manometry ◽  
Dysphagia Score ◽  
Demeester Score ◽  
Eckardt Score ◽  
Before And After ◽  
Endoscopic Myotomy ◽  
Diagnostic Work

Abstract Aim Assessment of the clinical outcomes, resolution of dysphagia, incidence of postoperative gastro-oesophageal reflux disease (GORD), and quality of life (QoL) of patients after POEM. Background&Methods POEM is increasingly performed worldwide for treatment of achalasia proving itself effective and safe. From a prospective database of all POEM’s performed in our institution from 2015 to 2018, we extracted data for patients with a minimum follow up period of 6 months. All patients underwent a standardized diagnostic work-up including gastroscopy, barium study and high-resolution manometry (HRM). Postoperatively, they had a surveillance gastroscopy in the 1st postoperative year. Standardized questionnaires evaluating Eckardt, GERD and achalasia QoL (Urbach) scores were completed before and after POEM. HRM and pH studies were offered to all patients after 6 months. Results Demographic data and procedure details can be seen in Table1. The preoperative Eckardt, GERD and Urbach scores changed significantly: the median Eckardt score of 7(4-11) decreased to a median of 1(1-9, p<0.001), the GERD score showed a reduction from 26(8-52) to 5(0-40, p<0.001) and Urbach score from 25(17-30) to 14(10-28, p<0.001). Furthermore, preoperative dysphagia score was significantly reduced from a median of 3(1-3) to a median of 0(0-3). Long-term clinical success (Eckardt score ≤ 3) was 87.2%. Postoperatively, 11 patients (29%) were taking PPI’s for chest symptoms. Nine of these agreed to undergo pH studies of whom only 1 had a DeMeester score > 14.5. Conclusion POEM is an effective and safe treatment option for achalasia with good relief of dysphagia and improvement in patients’ QoL.

Advanced achalasia: good candidate for peroral endoscopic myotomy

2020 ◽  
Author(s):  
Shaotian Qiu ◽  
Ningli Chai ◽  
Yaqi Zhai ◽  
Xiangyao Wang ◽  
Yan Wang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Success ◽  
Laparoscopic Heller Myotomy ◽  
Peroral Endoscopic Myotomy ◽  
Symptom Duration ◽  
Technical Success ◽  
Technical Success Rate ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Favorable Safety

SUMMARY Peroral endoscopic myotomy (POEM) has been increasingly accepted as the first-line treatment of achalasia. However, laparoscopic Heller myotomy or esophagectomy still remains as the mainstay treatment for advanced achalasia featured with megaesophagus and/or sigmoid-shaped esophagus. Although the efficacy of POEM for advanced achalasia with sigmoid-shaped esophagus has been described, little is known about the role of POEM for patients with megaesophagus. The aim of our study is to evaluate the efficacy and safety of POEM for advanced achalasia with megaesophagus. Patients who received initial examinations and underwent POEM in our hospital from June 2013 to December 2018 were identified and data were retrospectively analyzed. The advanced achalasia was defined as megaesophagus with a diameter of ≥6 cm. The primary outcome was clinical success. The secondary outcomes were technical success and adverse events. A total of 112 patients (50 females, 44.6%) were included with a mean age of 44.8 years. The median symptom duration was 6.5 years (IQR:3.0–13.0 years). Modified POEM techniques were used in 27.7% (31/112) of patients. Technical success rate was 99.1% (112/113) per procedure. Clinical success was seen in 93.1% patients with median Eckardt score decreasing from 8.0 to 1.0 (P &lt; 0.001) during a median 31.0 months of follow-up. The mean LES pressure decreased from 29.5 mmHg to 14.2 mmHg after POEM (P &lt; 0.05). Procedure-related adverse events occurred in 8.9% patients. Reflux disease was observed postoperatively in 26.7% of patients. POEM is also indicated for patients with advanced achalasia with a favorable safety and efficacy.

Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience

2021 ◽  
Author(s):  
S Bomman ◽  
J S Klair ◽  
M Ashat ◽  
R El Abiad ◽  
H Gerke ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Clinical Success ◽  
Botulinum Toxin Injection ◽  
Clinical Success Rate ◽  
Peroral Endoscopic Myotomy ◽  
Pneumatic Dilation ◽  
Type I ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
The Mean

Summary Peroral endoscopic myotomy (POEM) in patients with achalasia who are status post bariatric surgery may be technically challenging due to postsurgical scarring and altered anatomy. The aim of the study was to assess the efficacy and safety of POEM for achalasia in patients with prior bariatric surgery. A review of prospectively maintained databases at three tertiary referral centers from January 2015 to January 2021 was performed. The primary outcome of interest was clinical success, defined as a post-treatment Eckardt score ≤ 3 or improvement in Eckardt score by ≥ 1 when the baseline score was &lt;3, and improvement of symptoms. Secondary outcomes were adverse event rates and symptom recurrence. Sixteen patients status post Roux-en-Y gastric bypass (n = 14) and sleeve gastrectomy (n = 2) met inclusion criteria. Indications for POEM were achalasia type I (n = 2), type II (n = 9), and type III (n = 5). POEM was performed either by anterior or posterior approach. The pre-POEM mean integrated relaxation pressure was 26.2 ± 7.6 mm Hg. The mean total myotomy length was 10.2 ± 2.7 cm. The mean length of hospitalization was 1.4 ± 0.7 days. Pre- and postprocedure Eckardt scores were 6.1 ± 2.1 and 1.7 ± 1.8, respectively. The overall clinical success rate was 93.8% (15/16) with mean follow-up duration of 15.5 months. One patient had esophageal leak on postprocedure esophagram and managed endoscopically. Dysphagia recurred in two patients, which was successfully managed with pneumatic dilation with or without botulinum toxin injection. POEM appears to be safe and effective in the management of patients with achalasia who have undergone prior bariatric surgery.

scholarly journals Peroral Endoscopic Myotomy for Esophageal Achalasia in Portugal: Outcomes of the First Prospective Series

2020 ◽  
pp. 1-8
Author(s):  
Rui Mendo ◽  
Pedro Barreiro ◽  
José Rodrigues ◽  
Catarina Félix ◽  
Catarina O&apos;Neill ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Success ◽  
Peroral Endoscopic Myotomy ◽  
Successful Outcome ◽  
Consecutive Series ◽  
Procedure Time ◽  
Short Term ◽  
Invasive Treatment ◽  
Eckardt Score ◽  
Endoscopic Myotomy

<b><i>Background:</i></b> Peroral endoscopic myotomy (POEM) is an innovative achalasia treatment procedure that involves myotomy of the lower esophageal sphincter through a submucosal tunneling approach, combining the efficacy of surgical myotomy with the benefit of being a less invasive treatment. At this time, no data are available of POEM in Portugal. This study aimed to examine the safety and short-term outcomes of POEM in a Portuguese center. <b><i>Methods:</i></b> Fifty POEM were performed on 49 consecutive patients at our institution between January 2017 and January 2020. A prospective study of a consecutive series of patients was conducted, including procedure time, myotomy location and length, adverse events and clinical success. An Eckardt score of ≤3 after POEM was deemed as a successful outcome. Gastroesophageal reflux disease (GERD) was evaluated based on symptoms and on upper endoscopy, which was performed at 3–6 months postoperatively to check for reflux esophagitis. <b><i>Results:</i></b> POEM was successfully completed in all cases: 70% (<i>n</i> = 35) were naïve and 30% (<i>n</i> = 15) had previous treatments. The mean procedure time was 73.4 ± 22.6 min (range 45–125 min). There were no major adverse events. Minor adverse events were rare (8%), and there was no perioperative mortality. The Eckardt score significantly decreased from 6.9 ± 2.4 preoperatively to 0.5 ± 1.0 postoperatively (<i>p</i> &#x3c; 0.05). Overall clinical success was documented in 98, 98 and 95.2% at 1, 3 and 6 months, respectively. These short-term outcomes after POEM were independent of previous treatments. Symptomatic GERD was seen in 22.4% of patients. <b><i>Conclusions:</i></b> Our results confirm the safety and excellent short-term efficacy of POEM in a Portuguese center. This supports POEM as one of the first-line achalasia therapies in Portugal when performed by experienced operators.

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