Kamal Faisal, Khan Muhammad Ali, Lee-Smith Wade, Sharma Sachit, Acharya Ashu, Farooq Umer, Ejaz Zahid, Aziz Muhammad, Gangwani Manesh Kumar, Hayat Umar, Kumar Anand, Schlachterman Alexander, Loren David, Kowalski Thomas
Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, PA (Faisal Kamal, Anand Kumar, Alexander Schlachterman, David Loren, Thomas Kowalski).
Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX (Muhammad Ali Khan).
Ann Gastroenterol. 2024 Jul-Aug;37(4):403-409. doi: 10.20524/aog.2024.0890. Epub 2024 Jun 14.
Achalasia can cause disabling symptoms that may substantially impair the quality of life. Peroral endoscopic myotomy (POEM) has shown promising results in the management of achalasia. In this meta-analysis we have evaluated the feasibility and safety of single-session POEM with fundoplication (POEM+F) in patients with achalasia.
We reviewed several databases from inception to July 08, 2022, to identify studies evaluating the feasibility and/or safety of single-session POEM+F for patients with achalasia. Our outcomes of interest included the technical success of POEM+F, adverse events, esophagitis and wrap integrity on follow-up upper endoscopy, total procedure time, and fundoplication time. Pooled rates with 95% confidence intervals (CI) for outcomes were calculated using a random effect model. Heterogeneity was assessed using the statistic.
We included 4 studies with 90 patients. Pooled rates (95%CI) of technical success and adverse events were 92% (83-96%) and 5% (2-11%), respectively. Pooled rates (95%CI) of esophagitis and wrap integrity on follow-up upper endoscopy were 18% (11-30%) and 85% (43-98%) respectively. Pooled mean procedure time and fundoplication time were 113.2 (98.7-127.6) and 55.3 (43.7-66.8) min, respectively.
This meta-analysis demonstrates the feasibility and safety of POEM+F in patients with achalasia. More studies with long-term follow up are required to further validate these findings.
贲门失弛缓症可导致使人丧失能力的症状，严重影响生活质量。经口内镜下肌切开术（POEM）在贲门失弛缓症的治疗中已显示出有前景的结果。在这项荟萃分析中，我们评估了贲门失弛缓症患者单期POEM联合胃底折叠术（POEM+F）的可行性和安全性。
我们检索了从数据库建立至2022年7月8日的多个数据库，以识别评估单期POEM+F治疗贲门失弛缓症患者的可行性和/或安全性的研究。我们感兴趣的结果包括POEM+F的技术成功率、不良事件、随访上消化道内镜检查时的食管炎和胃底折叠完整性、总手术时间和胃底折叠时间。使用随机效应模型计算结果的合并率及95%置信区间（CI）。使用统计量评估异质性。
我们纳入了4项研究，共90例患者。技术成功率和不良事件的合并率（95%CI）分别为92%（83-96%）和5%（2-11%）。随访上消化道内镜检查时食管炎和胃底折叠完整性的合并率（95%CI）分别为18%（11-30%）和85%（43-98%）。平均总手术时间和胃底折叠时间分别为113.2（98.7-127.6）分钟和55.3（43.7-66.8）分钟。
这项荟萃分析证明了POEM+F治疗贲门失弛缓症患者的可行性和安全性。需要更多长期随访研究来进一步验证这些发现。
