Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Gurgaon, India.
Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, India.
Esophagus. 2024 Oct;21(4):419-429. doi: 10.1007/s10388-024-01076-6. Epub 2024 Aug 14.
Per‑oral endoscopic myotomy (POEM) is the preferred endoscopic modality for managing achalasia cardia. However, there are no recommendations on the role of POEM in non‑achalasia esophageal dysmotility disorders (NAEMD), including esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), and hypercontractile esophagus (HE). The present systematic review and meta-analysis aimed to assess the safety and efficacy of POEM in the treatment of NAEMD. MEDLINE, Embase, and Scopus were searched from inception to August 2023 for studies analyzing the outcome of POEM in NAEMD. Clinical success and adverse events were the main outcomes assessed. The event rates and their 95% confidence interval were calculated using a random effects model. A total of 11 studies with 271 patients were included in the final analysis. The pooled clinical success rate with POEM in NAEMD was 86.9% (82.9-90.9). On subgroup analysis, the pooled clinical success rates of POEM in DES and EGJOO were 97.8% (90.9-100.0) and 92.7% (86.3-95.1), which were significantly higher than in HE 81.2% (73.5-88.8). Data from limited studies showed that the pooled rate of improvement in dysphagia and chest pain was 88.5% (83.0-93.9) and 87.4% (80.5-94.4). The pooled incidence of overall AEs and serious AEs was 12.6% (5.7-19.5) and 0.3% (0.0-1.9), respectively. On follow-up, the pooled incidence of new-onset heartburn was 18.7% (11.1-26.2). POEM is a safe and efficacious treatment modality for the management of NAEMD with a lower clinical success in patients with HE. Further large-scale studies are required to validate the findings of the present analysis.
经口内镜下肌切开术（POEM）是治疗贲门失弛缓症的首选内镜治疗方法。然而，对于非贲门失弛缓症食管动力障碍疾病（NAEMD），包括食管胃结合部流出道梗阻（EGJOO）、远端食管痉挛（DES）和高收缩性食管（HE），目前尚无 POEM 治疗的推荐意见。本系统评价和荟萃分析旨在评估 POEM 治疗 NAEMD 的安全性和疗效。从建库至 2023 年 8 月，我们在 MEDLINE、Embase 和 Scopus 中检索了分析 POEM 治疗 NAEMD 结局的研究。主要评估临床疗效和不良事件。使用随机效应模型计算事件发生率及其 95%置信区间。最终分析共纳入 11 项研究，共 271 例患者。POEM 治疗 NAEMD 的总体临床成功率为 86.9%（82.9-90.9）。亚组分析显示，POEM 治疗 DES 和 EGJOO 的临床成功率分别为 97.8%（90.9-100.0）和 92.7%（86.3-95.1），明显高于 HE 的 81.2%（73.5-88.8）。来自有限研究的数据显示，POEM 改善吞咽困难和胸痛的总体缓解率分别为 88.5%（83.0-93.9）和 87.4%（80.5-94.4）。总体不良事件和严重不良事件的发生率分别为 12.6%（5.7-19.5）和 0.3%（0.0-1.9）。随访时，新发烧心的发生率为 18.7%（11.1-26.2）。POEM 是治疗 NAEMD 的一种安全有效的治疗方法，对于 HE 患者的临床疗效较低。需要进一步的大规模研究来验证本分析的结果。
