Department of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198, USA.
Department of Internal Medicine, Banner University Medical Center, Tucson, AZ, USA.
Surg Endosc. 2020 Feb;34(2):707-718. doi: 10.1007/s00464-019-06819-6. Epub 2019 May 9.
POEM has been successfully performed in patients with spastic esophageal disorders (SED), such as diffuse esophageal spasm, jackhammer esophagus, and type 3 achalasia. We performed a systematic review and meta-analysis to evaluate its efficacy in these patients and if total average myotomy length and prior medical or endoscopic treatments affected clinical success.
PubMed, EMBASE, Google-Scholar, Scopus, and Cochrane Review were searched for studies on POEM in SED from 2008 to September 2018. Clinical success was determined by Eckardt score (≤ 3) at follow-up. Sub-group analysis was performed based on myotomy length and evaluates the effect of prior treatments on clinical success.
9 studies with 210 patients were included in the final analysis. We found that the pooled rate of clinical success for POEM was 89.6% (95% CI 83.5-93.1, 95% PI 83.4-93.7, I = 0%). In three studies (50 patients), where total myotomy length was < 10 cm, the pooled rate of clinical success was 91.1% (95% CI 79.5-96.4, I = 0%). In six studies (160 patients), the length was > 10 cms and the pooled rate of clinical success was 89.1% (95% CI 83.0-93.2, I = 0%). The difference between these results was not statistically significant (p = 0.69). Additionally, a meta-regression analysis showed that prior treatment status did not significantly affect the primary outcome (p = 0.43).
While it is well known that POEM is a safe and effective treatment for spastic esophageal disorders, we conclude that variation in total myotomy length and prior endoscopic or medical treatments did not have a significant effect on clinical success.
经口内镜下肌切开术（POEM）已成功应用于治疗痉挛性食管疾病（SED），如弥漫性食管痉挛、胡桃夹食管和 3 型贲门失弛缓症。我们进行了系统回顾和荟萃分析，以评估其在这些患者中的疗效，以及总平均肌切开长度和既往的药物或内镜治疗是否会影响临床疗效。
从 2008 年至 2018 年 9 月，我们在 PubMed、EMBASE、Google Scholar、Scopus 和 Cochrane Review 中检索了关于 SED 中 POEM 的研究。临床疗效通过随访时的 Eckardt 评分（≤3）来确定。根据肌切开长度进行亚组分析，并评估既往治疗对临床疗效的影响。
最终分析纳入了 9 项研究共 210 例患者。我们发现，POEM 的临床疗效总有效率为 89.6%（95% CI 83.5-93.1，95% PI 83.4-93.7，I=0%）。在 3 项研究（50 例患者）中，总肌切开长度<10cm 时，临床疗效总有效率为 91.1%（95% CI 79.5-96.4，I=0%）。在 6 项研究（160 例患者）中，长度>10cm 时，临床疗效总有效率为 89.1%（95% CI 83.0-93.2，I=0%）。这些结果之间的差异无统计学意义（p=0.69）。此外，Meta 回归分析显示，既往治疗情况对主要结局无显著影响（p=0.43）。
虽然众所周知 POEM 是治疗痉挛性食管疾病的一种安全有效的方法，但我们的结论是，总肌切开长度和既往内镜或药物治疗的差异对临床疗效没有显著影响。
