Xu Jin, Zhong Chunyu, Huang Shu, Zeng Xinyi, Tan Shali, Shi Lei, Peng Yan, Lü Muhan, Ma Lianjun, Tang Xiaowei
Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Gastroenterology, the People's Hospital of Lianshui, Huaian, China.
Front Med (Lausanne). 2021 Jul 8;8:677694. doi: 10.3389/fmed.2021.677694. eCollection 2021.
The efficacy and safety of peroral endoscopic myotomy (POEM) in the treatment of sigmoid-type achalasia is unknown. This meta-analysis aims to explore the clinical outcomes of POEM for sigmoid-type achalasia. We searched all relevant studies published up to September 2020 in PubMed, Embase, and Cochrane library databases. Meta-analyses for clinical success, Eckardt score, angle of esophageal tortuosity, diameter of esophagus, lower esophageal sphincter (LES) pressure, integrated relaxation pressure (IRP), adverse events, and gastroesophageal reflux diseases were performed based on random or fixed-effects models as needed. We found a total of eight studies that provided data on 248 patients. Overall, the pooled clinical success was achieved in 211 sigmoid-type achalasia patients [90.4%; 95% confidence interval (CI), 85.5%-93.8%]. The pre- and post-POEM Eckardt scores, angle of esophageal tortuosity, diameter of esophageal, LES pressure, and IRP were significantly improved (All < 0.05). The pooled adverse events rate was 13.0% (95% CI, 3.6%-37.4%). The pooled objective confirmation of reflux rate was 41.5% (95% CI, 26.5%-58.3%), and symptomatic reflux rate was 12.5% (95% CI, 8.3%-18.4%). Our current evidence indicated that POEM is an effective and safe therapeutic modality for the treatment of sigmoid-type achalasia.
经口内镜下肌切开术（POEM）治疗乙状结肠型贲门失弛缓症的疗效和安全性尚不清楚。本荟萃分析旨在探讨POEM治疗乙状结肠型贲门失弛缓症的临床疗效。我们检索了截至2020年9月在PubMed、Embase和Cochrane图书馆数据库中发表的所有相关研究。根据需要，基于随机或固定效应模型对临床成功率、埃卡特评分、食管迂曲角度、食管直径、食管下括约肌（LES）压力、综合松弛压力（IRP）、不良事件和胃食管反流病进行荟萃分析。我们共发现八项研究，提供了248例患者的数据。总体而言，211例乙状结肠型贲门失弛缓症患者取得了合并临床成功[90.4%；95%置信区间（CI），85.5%-93.8%]。POEM术前和术后的埃卡特评分、食管迂曲角度、食管直径、LES压力和IRP均有显著改善（均P<0.05）。合并不良事件发生率为13.0%（95%CI，3.6%-37.4%）。合并客观反流证实率为41.5%（95%CI，26.5%-58.3%），症状性反流率为12.5%（95%CI，8.3%-18.4%）。我们目前的证据表明，POEM是治疗乙状结肠型贲门失弛缓症的一种有效且安全的治疗方式。
