Mandavdhare Harshal S, M Praveen Kumar, Shukla Jayendra, Kumar Antriksh, Sharma Vishal
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Neurogastroenterol Motil. 2022 Jan 30;28(1):15-27. doi: 10.5056/jnm21122.
BACKGROUND/AIMS: Sigmoid esophagus and/or megaesophagus are considered as an advanced stage in the natural history of achalasia cardia. The role of peroral endoscopic myotomy (POEM) in these subset of patients is emerging. We performed a systematic review and metanalysis to study the efficacy of POEM in advanced achalasia cardia with sigmoid and megaesophagus.
A literature search in PubMed and Embase was done from inception till August 3, 2021 to look for studies reporting exclusively on the role of POEM in advanced achalasia cardia with sigmoid and/or megaesophagus. The random effect method with inverse variance approach was used for the computation of pooled prevalence. For 2 groups' analysis of continuous outcome standardized mean difference was used as the summary measure.
Eleven studies with 428 patients were included for analysis. The pooled technical and clinical success was 98.27% (95% CI, 96.19-99.22; I = 0%) and 89.38% (95% CI, 84.49-92.86; I = 26%) and on subgroup analysis into sigmoid and megaesophagus it was (98.06% [95% CI, 95.41-99.19; I = 0%], 98.47% [95% CI, 92.72-99.69; I = 0%] and 87.92% [95% CI, 80.68-92.70; I = 37%], 88.36% [95% CI, 62.62-97.17; I = 77%]) respectively. The clinical success at < 1 year and 1-3 year follow-up was 89.37% (95% CI, 82.82-93.61; I = 0%) and 88.66% (95% CI, 81.65-91.22; I = 46%) respectively. There was a significant reduction in the post-POEM scores with standardized mean difference for Eckardt score (4.81), for integrated relaxation pressure at 4 seconds (1.93), and for lower esophageal sphincter pressure (2.06).
POEM is an effective modality of treatment even in the subset of patients of advanced achalasia cardia with sigmoid and megaesophagus.
背景/目的：乙状结肠型食管和/或巨食管被认为是贲门失弛缓症自然病程中的晚期阶段。经口内镜下肌切开术（POEM）在这类患者中的作用正在显现。我们进行了一项系统评价和荟萃分析，以研究POEM在伴有乙状结肠型食管和巨食管的晚期贲门失弛缓症中的疗效。
在PubMed和Embase数据库中从建库至2021年8月3日进行文献检索，以寻找专门报道POEM在伴有乙状结肠型食管和/或巨食管的晚期贲门失弛缓症中作用的研究。采用具有逆方差法的随机效应模型计算合并患病率。对于两组连续结局的分析，采用标准化均数差作为汇总指标。
纳入11项研究共428例患者进行分析。技术成功率和临床成功率的合并值分别为98.27%（95%CI，96.19 - 99.22；I² = 0%）和89.38%（95%CI，84.49 - 92.86；I² = 26%），亚组分析乙状结肠型食管和巨食管时分别为（98.06%[95%CI，95.41 - 99.19；I² = 0%]，98.47%[95%CI，92.72 - 99.69；I² = 0%]和87.92%[95%CI，80.68 - 92.70；I² = 37%]，88.36%[95%CI，62.62 - 97.17；I² = 77%]）。术后1年内和1 - 3年随访时的临床成功率分别为89.37%（95%CI，82.82 - 93.61；I² = 0%）和88.66%（95%CI，81.65 - 91.22；I² = 46%）。POEM术后Eckardt评分的标准化均数差（4.81）、4秒时综合松弛压的标准化均数差（1.93）以及食管下括约肌压力的标准化均数差（2.06）均有显著降低。
即使在伴有乙状结肠型食管和巨食管的晚期贲门失弛缓症患者亚组中，POEM也是一种有效的治疗方式。
