Is POEM the Answer for Management of Spastic Esophageal Disorders? A Systematic Review and Meta-Analysis

被引：118

作者：

Khan, Muhammad Ali ^{[1
]}

Kumbhari, Vivek ^{[2
]}

Ngamruengphong, Saowanee ^{[2
]}

Ismail, Amr ^{[2
]}

Chen, Yen-I ^{[2
]}

Chavez, Yamile Haito ^{[2
]}

Bukhari, Majidah ^{[2
]}

Nollan, Richard ^{[1
]}

Ismail, Mohammad Kashif ^{[1
]}

Onimaru, Manabu ^{[3
]}

Balassone, Valerio ^{[3
]}

Sharata, Ahmed ^{[4
]}

Swanstrom, Lee ^{[4
]}

Inoue, Haruhiro ^{[3
]}

Repici, Alessandro ^{[5
]}

Khashab, Mouen A. ^{[2
]}

机构：

[1] Univ Tennessee, Hlth Sci Ctr, Div Gastroenterol & Hepatol, Memphis, TN 38163 USA

[2] Johns Hopkins Univ Hosp, Div Gastroenterol & Hepatol, 1800 Orleans St,Suite 7125 B, Baltimore, MD 21205 USA

[3] Showa Univ, Koto Toyosu Hosp, Ctr Digest Dis, Tokyo, Japan

[4] Oregon Clin, Gastrointestinal & Minimally Invas Surg Div, Portland, OR 97232 USA

[5] Humanitas Univ, Milan, Italy

来源：

DIGESTIVE DISEASES AND SCIENCES | 2017年 / 62卷 / 01期

关键词：

POEM; Spastic esophageal disorders; Achalasia; Jackhammer esophagus; Diffuse esophageal spasm; Spastic achalasia; PERORAL ENDOSCOPIC MYOTOMY; FOLLOW-UP; ACHALASIA; MOTILITY; CLASSIFICATION; PREDICTS; OUTCOMES; THERAPY; SAFETY;

D O I：

10.1007/s10620-016-4373-1

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background and Aims Spastic esophageal disorders (SEDs) include spastic achalasia (type III), diffuse esophageal spasm (DES), and nutcracker/jackhammer esophagus (JH). Per-oral endoscopic myotomy (POEM) has demonstrated efficacy and safety in the treatment of achalasia. Recently, POEM has been indicated for the treatment of SEDs. We conducted a systematic review and meta-analysis to determine the clinical success and safety of POEM in SEDs. Methods We searched several databases from 01/01/2007 to 01/10/2016 to identify studies (with five or more patients) on POEM for the treatment of SEDs. Weighted pooled rates (WPRs) for clinical success and adverse events (AEs) were calculated for all SEDs. Clinical success was defined as Eckardt scores of <= 3 and/or improvement in severity of dysphagia based on achalasia disease-specific health-related quality of life questionnaire. The WPRs for clinical success and AEs were analyzed using fixed- or random-effects model based on heterogeneity. The proportionate difference in clinical success and post-procedure adverse event rates among individual types of SEDs was also calculated. Results A total of eight observational studies with 179 patients were included in the final analysis. Two studies were of good quality and six were of fair quality based on the National Institutes of Health quality assessment tool. The WPR with 95% confidence interval (CI) for cumulative clinical success of POEM in all SEDs was 87% (78, 93%), I (2) = 37%. The total number of patients for individual disorders, i.e., type III achalasia, JH, and DES, was 116, 37, and 18, respectively. The WPRs for clinical success of POEM for type III achalasia, DES, and JH were 92, 88, and 72%, respectively. Proportion difference of WPR for clinical success was significantly higher for type III achalasia in comparison with JH (20%, P = 0.01). The WPR with 95% CI for AEs of POEM in all SEDs was 14% (9, 20%), I (2) = 0%. The WPRs for post-procedure adverse events for type III achalasia, DES, and JH were 11, 14, and 16%, respectively. There was no difference in safety of POEM among individual SEDs. Conclusion POEM is an effective and safe therapeutic modality for the treatment of spastic esophageal disorders.

引用

页码：35 / 44

页数：10

共 34 条

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