TY - JOUR
T1 - Feasibility and safety of peroral endoscopic myotomy with fundoplication in patients with achalasia
T2 - a systematic review and meta-analysis
AU - Kamal, Faisal
AU - Khan, Muhammad Ali
AU - Lee-Smith, Wade
AU - Sharma, Sachit
AU - Acharya, Ashu
AU - Farooq, Umer
AU - Ejaz, Zahid
AU - Aziz, Muhammad
AU - Gangwani, Manesh Kumar
AU - Hayat, Umar
AU - Kumar, Anand
AU - Schlachterman, Alexander
AU - Loren, David
AU - Kowalski, Thomas
N1 - Publisher Copyright:
© 2024 Hellenic Society of Gastroenterology.
PY - 2024/7/12
Y1 - 2024/7/12
N2 - BACKGROUND: 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.METHODS: 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
I
2 statistic.
RESULTS: 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.CONCLUSIONS: 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.
AB - BACKGROUND: 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.METHODS: 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
I
2 statistic.
RESULTS: 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.CONCLUSIONS: 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.
KW - Peroral endoscopic myotomy
KW - achalasia
KW - fundoplication
KW - meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=85199264015&partnerID=8YFLogxK
U2 - 10.20524/aog.2024.0890
DO - 10.20524/aog.2024.0890
M3 - Article
C2 - 38974079
AN - SCOPUS:85199264015
SN - 1108-7471
VL - 37
SP - 403
EP - 409
JO - Annals of Gastroenterology
JF - Annals of Gastroenterology
IS - 4
ER -