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      The 2 years’ long-term efficacy and safety of peroral endoscopic myotomy for the treatment of achalasia: a systematic review

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          Abstract

          Aim

          In this retrospective review, we aimed to investigate the long-term efficacy and safety of POEM with follow-up period over 2 years.

          Materials and methods

          A systematic review related to POEM for achalasia was conducted. A literature search was performed in Pubmed, Medline, Ovid, Cochrane and EBSCO databases on November 2017. The following postoperative outcomes were extracted: Eckardt score, lower esophageal sphincter pressure, complications and clinical success.

          Results

          The total number of patients was 373. The mean operative time was 66.7 min and the overall rate of complications was 21.2%. The mean follow-up period was 30.0 months. The overall clinical success rate was 92.9% and the rate of gastroesophageal reflux disease was 10.2%. Rate of mortality after POEM was 0.

          Conclusions

          Our study demonstrated that POEM is effective and safe for treating achalasia during the long-term followed up over 2 years.

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          Most cited references32

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          Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity.

          Anthony N. Kalloo, Vikesh K. Singh, Sanjay B Jagannath … (2004)
          A novel endoscopic peroral transgastric approach to the peritoneal cavity was tested in a porcine model in acute and long-term survival experiments. Transgastric peritoneoscopy was evaluated in 50-kg pigs. After upper endoscopy, the peritoneal cavity was accessed by needle-knife puncture of the gastric wall, followed by extension of the incision either with a pull-type sphincterotome or by balloon dilation. The peritoneal cavity was examined, and a liver biopsy specimen was obtained. The gastric wall incision was closed with clips. Twelve acute and 5 survival experiments were performed. Both techniques of gastric wall incision were without complication. The acute experiments demonstrated the technical feasibility of the approach. In the survival experiments, all pigs recovered and gained weight. The peroral transgastric approach to peritoneal cavity technically is feasible and has the potential to be an alternative to laparoscopy and laparotomy.
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            Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia.

            P Pasricha, R Hawari, I. Ahmed … (2007)
            The most permanent method of treating achalasia is a surgical myotomy. Because of the requirement for a mucosal incision and the risk of perforation, this procedure has not generally been approached endoscopically. We hypothesized that we could perform a safe and robust myotomy by working in the submucosal space, accessed from the esophageal lumen. Four pigs were used for this experiment. Baseline lower esophageal sphincter (LES) pressures were recorded and the pigs underwent upper endoscopy using a standard endoscope. A submucosal saline lift was created approximately 5 cm above the LES and a small nick was made in the mucosa in order to facilitate the introduction of a dilating balloon. After dilation, the scope was introduced over the balloon into the submucosal space and advanced toward the now visible fibers of the LES. The circular layer of muscle was then cleanly incised using an electrocautery knife in a distal-to-proximal fashion, without complications. The scope was then withdrawn back into the lumen and the mucosal defect was closed with endoscopically applied clips. The entire procedure took less than 15 minutes. Manometry was repeated on day 5 after the procedure and the animals were euthanized on day 7. LES pressures fell significantly from an average of 16.4 mm Hg to an average of 6.7 mm Hg after the myotomy. The necropsy examinations revealed no evidence of mediastinitis or peritonitis. Endoscopic submucosal esophageal myotomy is feasible, safe, and effective in the short term. It has the potential for being useful in patients with achalasia. The submucosal space is a novel and potentially important field of operation for endoscopic procedures.
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              Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study

              Vivek Kumbhari, Alan H Tieu, Manabu Onimaru … (2015)
              Background and study aims: Type III achalasia is characterized by rapidly propagating pressurization attributable to spastic contractions. Although laparoscopic Heller myotomy (LHM) is the current gold standard management for type III achalasia, peroral endoscopic myotomy (POEM) is conceivably superior because it allows for a longer myotomy. Our aims were to compare the efficacy and safety of POEM with LHM for type III achalasia patients. Patients and methods: A retrospective study of 49 patients who underwent POEM for type III achalasia across eight centers were compared to 26 patients who underwent LHM at a single institution. Procedural data were abstracted and pre- and post-procedural symptoms were recorded. Clinical response was defined by improvement of symptoms and decrease in Eckardt stage to ≤ 1. Secondary outcomes included length of myotomy, procedure duration, length of hospital stay, and rate of adverse events. Results: Clinical response was significantly more frequent in the POEM cohort (98.0 % vs 80.8 %; P = 0.01). POEM patients had significantly shorter mean procedure time than LHM patients (102 min vs 264 min; P < 0.01) despite longer length of myotomy (16 cm vs 8 cm; P < 0.01). There was no significant difference between POEM and LHM in the length of hospital stay (3.3 days vs 3.2 days; P = 0.68), respectively. Rate of adverse events was significantly less in the POEM group (6 % vs 27 %; P < 0.01). Conclusions: POEM allows for a longer myotomy than LHM, which may result in improved clinical outcomes. POEM appears to be an effective and safe alternative to LHM in patients with type III achalasia.
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                Author and article information

                Contributors
                Huan Li: 2650540927@qq.com
                Wei Peng: 745509372@qq.com
                Shu Huang: 0826hxs@163.com
                Yutang Ren: pumcren@126.com
                Yan Peng: 1806857826@qq.com
                Qing Li: 2375435621@qq.com
                Jiao Wu: 1107910010@qq.com
                Xiangsheng Fu: +86 817 2262407 , drfuxs@gmail.com
                Xiaowei Tang: +8608303165200 , solitude5834@hotmail.com
                Journal
                Journal ID (nlm-ta): J Cardiothorac Surg
                Journal ID (iso-abbrev): J Cardiothorac Surg
                Title: Journal of Cardiothoracic Surgery
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1749-8090
                Publication date (Electronic): 3 January 2019
                Publication date PMC-release: 3 January 2019
                Publication date Collection: 2019
                Volume: 14
                Electronic Location Identifier: 1
                Affiliations
                [1 ]GRID grid.410578.f, Department of Gastroenterology, , Affliated Hospital of Southwest Medical University, ; Street Taiping No.25, Region Jiangyang, Luzhou, 646099 Sichuan Province China
                [2 ]Department of Gastroenterology, the People’s Hospital of Lianshui, Huaian, China
                [3 ]ISNI 0000 0001 0662 3178, GRID grid.12527.33, Departmemt of Gastroenterology, , Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, ; Beijing, China
                [4 ]ISNI 0000 0004 1758 177X, GRID grid.413387.a, Department of Gastroenterology, , Affiliated Hospital of North Sichuan Medical College, ; Road Wenhua 63#, Region Shunqing, Sichuan, 637000 China
                Article
                Publisher ID: 811
                DOI: 10.1186/s13019-018-0811-9
                PMC ID: 6318943
                PubMed ID: 30606216
                SO-VID: 8e76fb34-9788-4f9a-8f6e-40e65c1a1015
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 7 April 2018
                Date accepted : 3 December 2018
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Surgery
                Keywords: peroral endoscopic myotomy,achalasia,clinical success,complications,efficacy,systematic review
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: peroral endoscopic myotomy, achalasia, clinical success, complications, efficacy, systematic review

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