GERD after per-oral endoscopic myotomy as compared with Heller’s myotomy with fundoplication: a systematic review with meta-analysis

Repici, Alessandro; Fuccio, Lorenzo; Maselli, Roberta; Mazza, Fabrizio; Correale, Loredana; Mandolesi, Daniele; Bellisario, Cristina; Sethi, Amrita; Khashab, Mouen A.; Rösch, Thomas; Hassan, Cesare

doi:10.1016/j.gie.2017.10.022

Cited by 222 publications

(190 citation statements)

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“…Nevertheless, others have reported that rates of patients with abnormal acid exposure (i.e. abnormal pH) in esophagus after POEM reaches 39‐47%, although rates of symptomatic GERD and erosive esophagitis remains low at 8.5‐19% and 13‐29%, respectively . As to reasons for this discrepancy, two factors are considered for the risk of GERD post POEM : prolonged extended myotomy of the gastric wall and dissection of collar sling muscle which suspends the angle of His.…”

Section: Clinical Questions and Statementsmentioning

confidence: 99%

Clinical practice guidelines for peroral endoscopic myotomy

Inoue

Shiwaku

Iwakiri

et al. 2018

Digestive Endoscopy

126

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Peroral endoscopic myotomy (POEM) is a novel clinical technique developed in Japan used to treat esophageal achalasia and esophageal motility disorders. This technique has been rapidly accepted and widely disseminated throughout our clinical practice because of its low invasiveness, technical novelty, and high efficacy. Since the advent of POEM, there have been no clinical guidelines that clearly indicated its standard of care, and these guidelines have been anticipated both nationally and internationally by clinicians who engage in POEM practice. In 2017, to meet these needs, the Japan Gastroenterological Endoscopy Society (JGES) launched the guideline committee for POEM. Based on the guideline development process proposed by the Medical Information Network Distribution Service (MINDS), the guideline committee initially created research questions on POEM and conducted a systematic review and meta-analysis on each topic. The clinical research extracted from databases for these clinical questions and the systematic review mainly comprised a few retrospective studies with a small number of participants and short trial periods; hence, the strength of the evidence and recommendations derived from these results was low. Throughout this process, the guideline committee met thrice: once on May 13, 2017, and again on September 17, 2017, to formulate the draft. A consensus meeting was then held on January 14, 2018, in Tokyo to establish the guideline statements and finalize the recommendations using the modified Delphi method. This manuscript presents clinical guidelines regarding current standards of practice and recommendations in terms of the nine chief topics in POEM.

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Section: Clinical Questions and Statementsmentioning

confidence: 99%

Clinical practice guidelines for peroral endoscopic myotomy

Inoue

Shiwaku

Iwakiri

et al. 2018

Digestive Endoscopy

126

155

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“…23 This was reported across all 3 parameters, symptoms (19.0% POEM vs 8.8%t LHM), abnormal pH study (39% POEM vs 17% LHM), and esophagitis (28%t POEM vs 7.6% LHM). 23 Long-term follow-up studies after LHM and PD revealed a nontrivial incidence of Barrett's esophagus and esophageal adenocarcinoma. [24][25][26][27] Such studies with long follow-up do not yet exist for POEM; however, the first case of early BE cancer 4 years after POEM was reported recently.…”

Section: Mentoring Education and Training Cornermentioning

confidence: 69%

“…3 However, only 8.5% of patients had symptomatic GERD. Another systematic review by Repici et al 23 showed that the incidence of reflux was 2-to 3-fold higher in patients after POEM as compared with those who had undergone LHM with fundoplication. 23 This was reported across all 3 parameters, symptoms (19.0% POEM vs 8.8%t LHM), abnormal pH study (39% POEM vs 17% LHM), and esophagitis (28%t POEM vs 7.6% LHM).…”

Section: Mentoring Education and Training Cornermentioning

confidence: 99%

“…Another systematic review by Repici et al 23 showed that the incidence of reflux was 2-to 3-fold higher in patients after POEM as compared with those who had undergone LHM with fundoplication. 23 This was reported across all 3 parameters, symptoms (19.0% POEM vs 8.8%t LHM), abnormal pH study (39% POEM vs 17% LHM), and esophagitis (28%t POEM vs 7.6% LHM). 23 Long-term follow-up studies after LHM and PD revealed a nontrivial incidence of Barrett's esophagus and esophageal adenocarcinoma.…”

Section: Mentoring Education and Training Cornermentioning

confidence: 99%

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How to Perform a High-Quality PerOral Endoscopic Myotomy?

et al. 2019

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“…Die Rate an postoperativem gastroösophagealem Reflux ist nach POEM im Vergleich zur LHM erhöht, was auch wichtigster Gegenstand der aktuellen akademischen Debatte ist [48,50,53]. Die Patienten haben subjektiv häufiger Refluxsymptome (Symptomevaluation), eine erhöhte Refluxösophagitisrate (Endoskopie) und auch eine messbar erhöhte Säureexposition (pH-Metrie).…”

Section: Ergebnisse Poem: Erhöhte Postoperative Refluxrateunclassified

Aktuelle Therapie der Achalasie 2019

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ZusammenfassungDie Therapie der primär idiopathischen Achalasie, der häufigsten der seltenen Ösophagusmotilitätsstörungen, unterliegt derzeit einem Wandel. Zunehmend setzt sich das Prinzip der „Heller-Myotomie“ als Standard durch. Mit der von dem deutschen Chirurgen Ernst Heller im Jahr 1913 erstbeschriebenen Kardiomyotomie lässt sich meist eine sehr gute Symptomkontrolle erzielen. Metaanalysen randomisierter Studien (Level-1A-Evidenz) zeigen die Überlegenheit der laparoskopischen Heller-Myotomie (LHM) gegenüber der pneumatischen Dilatation (PD). Protagonisten der PD beziehen sich zumeist auf die Ergebnisse der europäischen Multicenterstudie, die mit häufig wiederholten PD vergleichbare Ergebnisse wie die LHM erzielt hat, mit allerdings einer (nicht Intention-to-treat inkludierten) initialen PD-Serie mit inakzeptabel hoher Perforationsrate (33%). Zur Prävention eines postoperativen gastroösophagealen Refluxes (GER) nach LHM ist die Hinzunahme einer Fundoplicatio obligat. Die Manschette der Wahl ist die anteriore 180°-Fundoplicatio nach Dor. Allerdings wird dieser Standard (LHM + Dor-Prozedur) nun bereits wieder herausgefordert. Die 2010 durch Haruhiro Inoue eingeführte und seither weltweit klinisch erprobte perorale endoskopische Myotomie (POEM) ermöglicht die Durchführung der „Heller-Myotomie“ auf rein endoskopischem Wege. Die Komplikationsraten von POEM sind gering, die Symptomkontrolle ist in systematischen Reviews der publizierten Serien zur LHM vergleichbar oder sogar diskret überlegen. Vorteile der POEM sind u. a. die Möglichkeit, eine lange Myotomie (erforderlichenfalls des gesamten Ösophagus) durchzuführen und die relativ freie Wählbarkeit der Lokalisation der Myotomie (anteriores/posteriores POEM). Nachteile von POEM sind die bewiesen höhere postoperative Refluxrate nach POEM im Vergleich zur LHM, bei allerdings meist guter Behandelbarkeit des Refluxes mit PPI, erforderlichenfalls (selten) nachträglicher laparoskopischer Dor-Fundoplicatio. (Vorläufige) Ergebnisse von 2 prospektiv randomisierten Studien zeigen die Überlegenheit der POEM gegenüber der PD und Gleichwertigkeit der POEM zu LHM + Dor-Prozedur, bei erhöhtem GER. Im eigenen Vorgehen werden POEM und LHM in einem „Tailored Approach“ (maßgeschneidert) verwendet: POEM wird bevorzugt bei Typ III und Typ II mit Brustschmerzen, LHM bei sigmoidaler Achalasie und morphologischen Begleitveränderungen (Hernie, Divertikel etc.), ansonsten liberalere Verfahrenswahl.

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GERD after per-oral endoscopic myotomy as compared with Heller’s myotomy with fundoplication: a systematic review with meta-analysis

Cited by 222 publications

References 57 publications

Clinical practice guidelines for peroral endoscopic myotomy

Clinical practice guidelines for peroral endoscopic myotomy

How to Perform a High-Quality PerOral Endoscopic Myotomy?

Aktuelle Therapie der Achalasie 2019

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