Gopakumar Harishankar, Annor Eugene, Vohra Ishaan, Andalib Iman, Tyberg Amy, Sarkar Avik, Shahid Haroon, Carames Mine, Carames Juan Carlos, Gularte Giovanna Porfilio, Al-Lehibi Abed, Alkhiari Resheed, Bapaye Amol, Robles-Medranda Carlos, Kahaleh Michel
Gastroenterology and Hepatology, OSF Saint Joseph Medical Center, Bloomington, United States.
Department of Internal Medicine, University of Illinois Chicago College of Medicine at Peoria, Peoria, United States.
Endosc Int Open. 2025 Mar 14;13:a25368132. doi: 10.1055/a-2536-8132. eCollection 2025.
Gastroesophageal reflux (GER) and its long-term sequelae remain a concern following peroral endoscopic myotomy (POEM). POEM with fundoplication (POEM-F) is simultaneous fundoplication via pure natural orifice transluminal endoscopic surgery (NOTES). In this study, we evaluated the efficacy and safety of POEM-F in mitigating post-POEM GER.
We performed a comprehensive electronic database search from January 2008 through June 2024 for studies evaluating outcomes of POEM-F performed for managing post-POEM GER. Pooled proportions were calculated using random-effects models. Heterogeneity was assessed using I and Q statistics.
We included seven studies comprising 127 patients. Pooled technical success for POEM was 96.90%; 95% confidence interval [CI] 91.40-98.90. Pooled technical success of fundoplication was 92.30%; 95% CI 85.20-96.10. Clinical success in treating achalasia was 96.40%; 95% CI 90.70-98.60. Rate of wrap integrity on follow-up was 84.00%; 95% CI 66.00-93.40. Composite clinical success of POEM-F in mitigating post-POEM GER was 86.20%; 95% CI 73.80-93.20. Mean total procedure duration and fundoplication time was 115.74 minutes; 95% CI 103.53-126.96 and 55.28 minutes; 95% CI 47.35-63.20, respectively. The overall pooled major adverse events (AE) rate was 3.60%; 95% CI 1.40-9.40.
POEM-F is an effective procedure with an acceptable AE rate in expert hands. It appears to offer clinical benefit in mitigating post-POEM GER. However, further standardization for evaluating clinically significant post-POEM GER and long-term benefit of POEM-F is warranted.
经口内镜下肌切开术（POEM）后，胃食管反流（GER）及其长期后遗症仍是一个令人担忧的问题。POEM联合胃底折叠术（POEM-F）是通过纯天然腔镜下经自然腔道内镜手术（NOTES）同时进行胃底折叠术。在本研究中，我们评估了POEM-F在减轻POEM术后GER方面的疗效和安全性。
我们对2008年1月至2024年6月的电子数据库进行了全面检索，以查找评估POEM-F治疗POEM术后GER疗效的研究。使用随机效应模型计算合并比例。使用I²和Q统计量评估异质性。
我们纳入了7项研究，共127例患者。POEM的合并技术成功率为96.90%；95%置信区间[CI]为91.40 - 98.90。胃底折叠术的合并技术成功率为92.30%；95% CI为85.20 - 96.10。治疗贲门失弛缓症的临床成功率为96.40%；95% CI为90.70 - 98.60。随访时胃底折叠完整率为84.00%；95% CI为66.00 - 93.40。POEM-F减轻POEM术后GER的综合临床成功率为86.20%；95% CI为73.80 - 93.20。平均总手术时间和胃底折叠时间分别为115.74分钟；95% CI为103.53 - 126.96和55.28分钟；95% CI为47.35 - 63.20。总体合并严重不良事件（AE）发生率为3.60%；95% CI为1.40 - 9.40。
在专家手中，POEM-F是一种有效的手术方法，不良事件发生率可接受。它似乎在减轻POEM术后GER方面具有临床益处。然而，有必要进一步规范评估具有临床意义的POEM术后GER以及POEM-F的长期益处。
