Crespin Oscar M, Liu Louis W C, Parmar Ambica, Jackson Timothy D, Hamid Jemila, Shlomovitz Eran, Okrainec Allan
Division of General Surgery, University Health Network, Toronto, ON, Canada.
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Surg Endosc. 2017 May;31(5):2187-2201. doi: 10.1007/s00464-016-5217-y. Epub 2016 Sep 15.
Peroral endoscopic myotomy (POEM) is a novel intervention for the treatment of achalasia, which combines the advantages of endoscopic access and myotomy. The purpose of this study was to perform a systematic review of the literature to evaluate the efficacy and safety of POEM.
The systematic review was conducted following the PRISMA guidelines. Evidence-Based Medicine Reviews, Cochrane Central Register of Controlled Trials, Ovid MEDLINE (R) including in-process and non-indexed citations were searched for POEM studies using the keywords: esophageal achalasia, POEM, endoscopy, natural orifice surgery, laparoscopic Heller myotomy (LHM), and related terms. Eckardt score, lower esophageal sphincter (LES) pressure, and reported complications were the main outcomes. Two authors reviewed the search result independently. A third reviewer resolved all disagreements. Data abstraction was pilot-tested and approved by all authors. Data were examined for clinical, methodological, and statistical heterogeneity with the aim of determining whether evidence synthesis using meta- analysis was possible.
The search strategy retrieved 2894 citations. After removing duplicates and applying the exclusion criteria, 54 studies were selected for full-text review of which a total of 19 studies were considered eligible for further analysis. There were 10 retrospective and 9 prospective studies, including 1299 POEM procedures. No randomized control trial (RCT) was identified. Overall, the pre- and post-POEM Eckardt scores and LES pressure were significantly different. The most frequently reported complications were mucosal perforation, subcutaneous emphysema, pneumoperitoneum, pneumothorax, pneumomediastinum, pleural effusion, and pneumonia. The median follow-up was 13 months (range 3-24).
POEM is a safe and effective alternative for the treatment of achalasia. However, only short-term follow-up data compared with LHM are available. RCTs and long-term follow-up studies are needed to establish the efficacy and safety of POEM in the management of patients with achalasia.
经口内镜下肌切开术（POEM）是一种治疗贲门失弛缓症的新型干预方法，它结合了内镜入路和肌切开术的优点。本研究的目的是对文献进行系统评价，以评估POEM的疗效和安全性。
按照PRISMA指南进行系统评价。使用关键词“食管贲门失弛缓症”“POEM”“内镜检查”“自然腔道手术”“腹腔镜Heller肌切开术（LHM）”及相关术语，在循证医学评价、Cochrane对照试验中心注册库、Ovid MEDLINE（R）（包括正在进行的和未被索引的文献）中检索POEM相关研究。主要结局指标为 Eckardt评分、食管下括约肌（LES）压力及报告的并发症。两位作者独立审查检索结果。第三位审查者解决所有分歧。数据提取经过预试验并得到所有作者认可。对数据进行临床、方法学和统计学异质性检查，目的是确定是否可以使用荟萃分析进行证据合成。
检索策略共检索到2894篇文献。去除重复文献并应用排除标准后，选择54篇文献进行全文审查，其中共有19项研究被认为符合进一步分析的条件。有10项回顾性研究和9项前瞻性研究，包括1299例POEM手术。未发现随机对照试验（RCT）。总体而言，POEM术前和术后的Eckardt评分及LES压力有显著差异。最常报告的并发症为黏膜穿孔、皮下气肿、气腹、气胸、纵隔气肿、胸腔积液和肺炎。中位随访时间为13个月（范围3 - 24个月）。
POEM是治疗贲门失弛缓症的一种安全有效的替代方法。然而，与LHM相比，目前仅有短期随访数据。需要进行RCT和长期随访研究，以确定POEM在贲门失弛缓症患者管理中的疗效和安全性。
