Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN, USA.
Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, AL, USA.
Dig Dis Sci. 2021 Oct;66(10):3242-3249. doi: 10.1007/s10620-020-06678-5. Epub 2020 Oct 29.
Esophageal diverticula can cause significant symptoms and affect the quality of life. There has been recent interest in the use of peroral endoscopic myotomy in the management of esophageal diverticula (D-POEM). In this meta-analysis, we have evaluated the efficacy and safety of D-POEM in the management of esophageal diverticula. Several databases were reviewed from inception to 6/19/2020 to identify the studies evaluating the feasibility, efficacy and safety of D-POEM in the management of esophageal diverticula. Our outcomes of interest were technical success, adverse events and difference in mean pre- and post-procedure symptom score. We performed subgroup analysis including patients with Zenker's diverticulum who underwent POEM (Z-POEM). Pooled rates with 95% confidence intervals (CI) for all outcomes were calculated using random effect model. We calculated standard mean difference (SMD) with 95% CI to compare mean pre- and post-procedure symptom score. We included 7 studies with 233 patients. For D-POEM, pooled rates (95% CI) for technical success and adverse events were 95% (91%, 97%) and 6% (3%, 10%) respectively. For Z-POEM, pooled rates (95% CI) for technical success and adverse events were 95% (90%, 97%) and 6% (3%, 10%) respectively. Mean post-procedure symptom score for all patients who underwent D-POEM was significantly lower compared to mean pre-procedure symptom score, SMD (95% CI) 2.17 (1.51, 2.83). This meta-analysis demonstrated that D-POEM is a safe and feasible option for patients with symptomatic esophageal diverticula.
食管憩室可引起明显的症状并影响生活质量。目前人们对经口内镜肌切开术（D-POEM）治疗食管憩室的应用产生了浓厚的兴趣。在这项荟萃分析中，我们评估了 D-POEM 治疗食管憩室的疗效和安全性。从创建到 2020 年 6 月 19 日，我们对多个数据库进行了回顾，以确定评估 D-POEM 治疗食管憩室的可行性、疗效和安全性的研究。我们感兴趣的结果是技术成功率、不良事件以及术前和术后平均症状评分的差异。我们进行了亚组分析，包括接受经口内镜肌切开术（POEM）治疗 Zenker 憩室的患者（Z-POEM）。使用随机效应模型计算所有结果的汇总率及其 95%置信区间（CI）。我们计算了标准均数差（SMD）及其 95%CI，以比较术前和术后平均症状评分。我们纳入了 7 项研究，共 233 例患者。对于 D-POEM，技术成功率（95%CI）和不良事件发生率分别为 95%（91%，97%）和 6%（3%，10%）。对于 Z-POEM，技术成功率（95%CI）和不良事件发生率分别为 95%（90%，97%）和 6%（3%，10%）。所有接受 D-POEM 治疗的患者术后症状评分均明显低于术前，SMD（95%CI）为 2.17（1.51，2.83）。这项荟萃分析表明，D-POEM 是治疗有症状食管憩室患者的一种安全可行的选择。
