PMID- 32522483
OWN - NLM
STAT- MEDLINE
DCOM- 20210531
LR  - 20210531
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 93
IP  - 1
DP  - 2021 Jan
TI  - Peroral endoscopic myotomy for patients with achalasia with previous Heller 
      myotomy: a systematic review and meta-analysis.
PG  - 47-56.e5
LID - S0016-5107(20)34406-0 [pii]
LID - 10.1016/j.gie.2020.05.056 [doi]
AB  - BACKGROUND AND AIMS: Heller myotomy (HM) is considered the standard surgical 
      treatment for patients with achalasia. However, approximately 10% to 20% of 
      patients with achalasia have persistent or recurrent symptoms after HM that 
      require further therapy. Several studies have reported the outcomes of peroral 
      endoscopic myotomy (POEM) in these patients. We performed a systematic review and 
      meta-analysis to evaluate the efficacy and safety of POEM in patients with 
      achalasia with previous HM. METHODS: An electronic literature search of PubMed, 
      Embase, and the Cochrane Library was conducted up to January 31, 2020. Studies 
      evaluating the outcomes of POEM in patients with achalasia with previous HM were 
      eligible for inclusion. The primary outcomes were the pooled rates of clinical 
      success (defined as post-POEM Eckardt score </=3), mean change in Eckardt score, 
      lower esophageal sphincter pressure, and integrated relaxation pressure (IRP). 
      The secondary outcomes were procedure-related adverse events (AEs) and incidence 
      of postoperative GERD. RESULTS: A total of 9 studies involving 272 patients with 
      achalasia were recruited in this review. POEM was successfully performed in 270 
      (99.3%) patients after previous HM. Clinical success was achieved in 90.0% (95% 
      confidence interval [CI], 83.1%-96.8%) of patients. Eckardt score, lower 
      esophageal sphincter pressure, and IRP were significantly lowered by 5.14 (95% 
      CI, 4.19-6.09), 12.01 mm Hg (95% CI, 6.74-17.27), and 10.02 mm Hg (95% CI, 
      4.95-15.09), respectively. The pooled rates of postoperative symptomatic reflux, 
      esophagitis, and abnormal pH monitoring were 36.9% (95% CI, 20.7%-53.1%), 33.0% 
      (95% CI, 9.6%-56.4%), and 47.8% (95% CI, 33.4%-62.2%), respectively. Substantial 
      heterogeneity was detected across all outcome measurements. Most of the AEs were 
      self-limiting or managed conservatively. CONCLUSIONS: POEM is a safe and 
      effective treatment for patients with achalasia with previous HM. Further data 
      from prospective, controlled studies with long-term follow-up are needed to 
      confirm these findings.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Huang, Zhenzi
AU  - Huang Z
AD  - Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou, China.
FAU - Cui, Yi
AU  - Cui Y
AD  - Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou, China.
FAU - Li, Yuanqi
AU  - Li Y
AD  - Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou, China.
FAU - Chen, Minhu
AU  - Chen M
AD  - Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou, China.
FAU - Xing, Xiangbin
AU  - Xing X
AD  - Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20200611
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
CIN - Gastrointest Endosc. 2021 Jan;93(1):57-58. PMID: 33353641
MH  - *Esophageal Achalasia/surgery
MH  - Esophageal Sphincter, Lower/surgery
MH  - *Gastroesophageal Reflux
MH  - *Heller Myotomy
MH  - Humans
MH  - *Natural Orifice Endoscopic Surgery
MH  - Prospective Studies
MH  - Treatment Outcome
EDAT- 2020/06/12 06:00
MHDA- 2021/06/01 06:00
CRDT- 2020/06/12 06:00
PHST- 2019/12/14 00:00 [received]
PHST- 2020/05/17 00:00 [accepted]
PHST- 2020/06/12 06:00 [pubmed]
PHST- 2021/06/01 06:00 [medline]
PHST- 2020/06/12 06:00 [entrez]
AID - S0016-5107(20)34406-0 [pii]
AID - 10.1016/j.gie.2020.05.056 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2021 Jan;93(1):47-56.e5. doi: 10.1016/j.gie.2020.05.056. 
      Epub 2020 Jun 11.