PMID- 35291006
OWN - NLM
STAT- MEDLINE
DCOM- 20220816
LR  - 20220816
IS  - 1442-2050 (Electronic)
IS  - 1120-8694 (Linking)
VI  - 35
IP  - 8
DP  - 2022 Aug 13
TI  - Cost-efficient snare-assisted peroral endoscopic myotomy in comparison of 
      conventional endoscopic knife for treatment of achalasia: results of a randomized 
      controlled trial.
LID - doab099 [pii]
LID - 10.1093/dote/doab099 [doi]
AB  - BACKGROUND: To date, the ideal endoscopic knife for peroral endoscopic myotomy 
      (POEM) with good performance and cost-effectiveness is still under investigation. 
      The present study was aimed to evaluate the efficacy, safety, and 
      cost-effectiveness of snare-assisted POEM, compared with the conventional 
      endoscopic knife approach. METHODS: From May 2017 to December 2018, patients with 
      achalasia presenting for POEM without previous endoscopic or surgical therapy 
      were prospectively recruited in this randomized controlled trial. Patients were 
      randomly allocated to receive POEM using either the snare (snare group) or 
      HookKnife (conventional group). The primary outcome was clinical success (Eckardt 
      score </= 3) at 12-month follow-up, powered for noninferiority with a margin of 
      -15%. The secondary outcomes included adverse events (AEs), procedure-related 
      parameters, clinical outcomes, and cost-effectiveness. RESULTS: A total of 75 
      patients with similar baseline characteristics between the snare (N = 37) and 
      conventional (N = 38) groups were included. Clinical success at 12-month 
      follow-up was achieved in 94.6% of patients in the snare group and 92.1% of 
      patients in the conventional group (difference, 2.5% [95% CI, -8.7% to 13.7%]; 
      P < 0.001 for noninferiority). No severe AEs occurred in both groups. The use of 
      snare is associated with comparable procedure time (40.6 minutes vs. 
      42.5 minutes, P = 0.337), a lower frequency of hemostatic forceps use (27.0% vs. 
      68.4%, P < 0.001), and lower hospital costs ($4271.1 vs. $5327.3, P < 0.001). The 
      cost-effectiveness plane revealed that 96.9% of snare-assisted POEM procedures 
      offered more cost-savings and health utility benefits. CONCLUSIONS: The 
      snare-assisted POEM was noninferior to the conventional endoscopic knife approach 
      in terms of clinical efficacy, with comparable safety outcomes and cost-effective 
      benefits.
CI  - (c) The Author(s) 2022. Published by Oxford University Press on behalf of 
      International Society for Diseases of the Esophagus. All rights reserved. For 
      permissions, please e-mail: journals.permissions@oup.com.
FAU - Huang, Zhen-Zi
AU  - Huang ZZ
AD  - Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou 510080, China.
FAU - Mao, Ren
AU  - Mao R
AD  - Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou 510080, China.
FAU - Li, Yuan-Qi
AU  - Li YQ
AD  - Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou 510080, China.
FAU - Tian, Hong-Zhan
AU  - Tian HZ
AD  - Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou 510080, China.
FAU - Iacucci, Marietta
AU  - Iacucci M
AD  - National Institute of Health Research Biomedical Research Institute, Institute of 
      Translational Medicine, University of Birmingham and University Hospitals 
      Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK.
FAU - Shen, Bo
AU  - Shen B
AD  - Center for Interventional Inflammatory Bowel Disease, Columbia University Irving 
      Medical Center/New York Presbyterian Hospital, New York, NY 10032, USA.
FAU - Cui, Yi
AU  - Cui Y
AD  - Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou 510080, China.
FAU - Xiao, Ying-Lian
AU  - Xiao YL
AD  - Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou 510080, China.
FAU - Wang, Jin-Hui
AU  - Wang JH
AD  - Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou 510080, China.
FAU - Chen, Min-Hu
AU  - Chen MH
AD  - Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou 510080, China.
FAU - Xing, Xiang-Bin
AU  - Xing XB
AD  - Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen 
      University, Guangzhou 510080, China.
LA  - eng
GR  - 2015A030313116/Natural Science Foundation of Guangdong Province/
GR  - 2016A020215041/Science and Technology Planning Project of Guangdong Province/
GR  - 15ykpy18/Junior Teacher Cultivation Project of Sun Yat-sen University/
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - Dis Esophagus
JT  - Diseases of the esophagus : official journal of the International Society for 
      Diseases of the Esophagus
JID - 8809160
SB  - IM
MH  - *Digestive System Surgical Procedures
MH  - *Esophageal Achalasia/therapy
MH  - Esophageal Sphincter, Lower/surgery
MH  - Esophagoscopy/methods
MH  - Humans
MH  - *Myotomy/methods
MH  - *Natural Orifice Endoscopic Surgery/methods
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - achalasia
OT  - endoscopic knife
OT  - peroral endoscopic myotomy
OT  - randomized controlled trial
OT  - snare
EDAT- 2022/03/16 06:00
MHDA- 2022/08/17 06:00
CRDT- 2022/03/15 20:15
PHST- 2021/07/14 00:00 [received]
PHST- 2021/10/22 00:00 [revised]
PHST- 2022/03/16 06:00 [pubmed]
PHST- 2022/08/17 06:00 [medline]
PHST- 2022/03/15 20:15 [entrez]
AID - 6549064 [pii]
AID - 10.1093/dote/doab099 [doi]
PST - ppublish
SO  - Dis Esophagus. 2022 Aug 13;35(8):doab099. doi: 10.1093/dote/doab099.