PMID- 27858325
OWN - NLM
STAT- MEDLINE
DCOM- 20170710
LR  - 20181203
IS  - 1573-2568 (Electronic)
IS  - 0163-2116 (Linking)
VI  - 62
IP  - 1
DP  - 2017 Jan
TI  - Is POEM the Answer for Management of Spastic Esophageal Disorders? A Systematic 
      Review and Meta-Analysis.
PG  - 35-44
LID - 10.1007/s10620-016-4373-1 [doi]
AB  - 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.
FAU - Khan, Muhammad Ali
AU  - Khan MA
AD  - Division of Gastroenterology and Hepatology, University of Tennessee Health 
      Science Center, Memphis, TN, USA.
FAU - Kumbhari, Vivek
AU  - Kumbhari V
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans 
      St., Suite 7125 B, Baltimore, MD, 21205, USA.
FAU - Ngamruengphong, Saowanee
AU  - Ngamruengphong S
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans 
      St., Suite 7125 B, Baltimore, MD, 21205, USA.
FAU - Ismail, Amr
AU  - Ismail A
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans 
      St., Suite 7125 B, Baltimore, MD, 21205, USA.
FAU - Chen, Yen-I
AU  - Chen YI
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans 
      St., Suite 7125 B, Baltimore, MD, 21205, USA.
FAU - Chavez, Yamile Haito
AU  - Chavez YH
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans 
      St., Suite 7125 B, Baltimore, MD, 21205, USA.
FAU - Bukhari, Majidah
AU  - Bukhari M
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans 
      St., Suite 7125 B, Baltimore, MD, 21205, USA.
FAU - Nollan, Richard
AU  - Nollan R
AD  - Division of Gastroenterology and Hepatology, University of Tennessee Health 
      Science Center, Memphis, TN, USA.
FAU - Ismail, Mohammad Kashif
AU  - Ismail MK
AD  - Division of Gastroenterology and Hepatology, University of Tennessee Health 
      Science Center, Memphis, TN, USA.
FAU - Onimaru, Manabu
AU  - Onimaru M
AD  - Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
FAU - Balassone, Valerio
AU  - Balassone V
AD  - Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
FAU - Sharata, Ahmed
AU  - Sharata A
AD  - Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 
      Portland, OR, USA.
FAU - Swanstrom, Lee
AU  - Swanstrom L
AD  - Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, 
      Portland, OR, USA.
FAU - Inoue, Haruhiro
AU  - Inoue H
AD  - Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
FAU - Repici, Alessandro
AU  - Repici A
AD  - Humanitas University, Milan, Italy.
FAU - Khashab, Mouen A
AU  - Khashab MA
AD  - Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans 
      St., Suite 7125 B, Baltimore, MD, 21205, USA. mkhasha1@jhmi.edu.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20161117
PL  - United States
TA  - Dig Dis Sci
JT  - Digestive diseases and sciences
JID - 7902782
SB  - IM
MH  - Deglutition Disorders/etiology/*surgery
MH  - Esophageal Achalasia/complications/*surgery
MH  - Esophageal Motility Disorders/complications/surgery
MH  - Esophageal Spasm, Diffuse/complications/*surgery
MH  - Esophageal Sphincter, Lower/*surgery
MH  - Esophagoscopy
MH  - Esophagus/surgery
MH  - Gastroscopy
MH  - Humans
MH  - Natural Orifice Endoscopic Surgery
MH  - Quality of Life
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Achalasia
OT  - Diffuse esophageal spasm
OT  - Jackhammer esophagus
OT  - POEM
OT  - Spastic achalasia
OT  - Spastic esophageal disorders
EDAT- 2016/11/20 06:00
MHDA- 2017/07/14 06:00
CRDT- 2016/11/19 06:00
PHST- 2016/05/30 00:00 [received]
PHST- 2016/11/01 00:00 [accepted]
PHST- 2016/11/20 06:00 [pubmed]
PHST- 2017/07/14 06:00 [medline]
PHST- 2016/11/19 06:00 [entrez]
AID - 10.1007/s10620-016-4373-1 [pii]
AID - 10.1007/s10620-016-4373-1 [doi]
PST - ppublish
SO  - Dig Dis Sci. 2017 Jan;62(1):35-44. doi: 10.1007/s10620-016-4373-1. Epub 2016 Nov 
      17.