Peroral endoscopic myotomy for advanced achalasia with megaesophagus

Ueda, Chise; Abe, Hirofumi; Tanaka, Shinwa; Kawara, Fumiaki; Toyonaga, Takashi; Ariyoshi, Ryusuke; Sako, Tomoya; Sakaguchi, Hiroya; Ikezawa, Nobuaki; Urakami, Satoshi; Nakai, Tomoaki; Kodama, Yuzo

doi:10.1007/s10388-021-00833-1

Cited by 12 publications

(19 citation statements)

References 25 publications

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“…Table 1 shows the detailed demographic data of the included studies. 3 , 14 - 22 The study that fulfilled the inclusion criteria but was excluded with reason for exclusion is found in ( Supplementary Table ). 16 , 23 Of these 11 studies, 9 were single center retrospective and 1 each was single center prospective and multicenter retrospective.…”

Section: Resultsmentioning

confidence: 99%

“…All the 11 studied reported on technical and clinical success of POEM for advanced achalasia cardia with sigmoid and/or megaesophagus. Eight studies reported on sigmoid esophagus, 2 studies on megaesophagus (Ueda et al 14 and Qiu et al 22 while 1 study by Liu et al 5 reported on both sigmoid and megaesophagus. The pooled prevalence for technical success and clinical success was 98.27% (95% CI, 96.19-99.22; I 2 = 0%) and 89.38% (95% CI, 84.49-92.86; I 2 = 26%) respectively ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Out of the 11 studies, 2 studies mentioned adverse events as per the ASGE lexicon (Qiu et al 22 and Lv et al 24 ) while 2 studies used other criteria (Ueda et al 14 [IPOEMS] and Maruyama et al 20 [Clinical practice guidelines for POEM and JCOG PC] criteria). Five studies mentioned the adverse events as observations without using any criteria (Nabi et al, 16 Hu et al, 18 Fujiyoshi et al, 19 Sanaka et al, 21 and Lv et al 24 ).…”

Section: Resultsmentioning

confidence: 99%

“… 7 In addition we also noted the adverse event rate and was defined as per the American Society of Gastrointestinal Endoscopy (ASGE) lexicon 8 or International Per Oral Endoscopic Myotomy Survey Classification (IPOEMS) 9 or Clinical practice guidelines for POEM and Japan Clinical Oncology Group post-operative complications (JCOG PC) criteria 10 , 11 or noted as observational data. Apart from this, we looked for the following information: type of study (single/multicentre), type of sigmoid esophagus (Type 1 and Type 2 as per the CT classification–where Type 1 has only single bend and a single lumen on axial cut of CT, while Type 2 is S shaped and 2 lumens can be seen on axial CT image; 12 sigmoid and advanced sigmoid as per the descriptive rules of esophageal achalasia–where depending on the α angle [angle between 2 straight lines drawn along the long axis of the esophagus] it is defined a sigmoid when the α angle is < 135° and > 90° 13 and advanced sigmoid when the α angle is < 90° and megaesophgus if diameter is > 6 cm 14 ), type of achalasia cardia as per the Chicago classification version 3.0, 7 duration of symptoms in months, average diameter of the esophagus, previous treatments received, pre- and post-ES, pre- and post-4s-IRP, pre- and post-LESP, duration of follow-up, myotomy length, and definition used for sigmoid esophagus by individual study. For missing data in abstracts, we contacted the authors through electronic mail.…”

Section: The Outcome Definitions Used In the Study Are As Followsmentioning

confidence: 99%

“…Nine of the 11 studies fulfilled all the criteria of the Joanna Briggs critical appraisal tool for case series and cohort studies. 5 , 14 - 16 , 18 , 20 - 22 , 24 Two of the abstracts that were included were unclear regarding the statistical methods used for analysis 17 , 19 while 1 abstract was unclear regarding demographics of the participants and did not report the outcomes and follow-up results clearly. 5 The funnel plot for publication bias assessed for prevalence for clinical success showed no bias.…”

Section: Quality Assessment (See Table 3 )mentioning

confidence: 99%

See 4 more Smart Citations

Role of Peroral Endoscopic Myotomy in Advanced Achalasia Cardia With Sigmoid and/or Megaesophagus: A Systematic Review and Metanalysis

Mandavdhare

Kumar‐M

Shukla

et al. 2022

J Neurogastroenterol Motil

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Background/AimsSigmoid esophagus and/or megaesophagus are considered as an advanced stage in the natural history of achalasia cardia. The role of peroral endoscopic myotomy (POEM) in these subset of patients is emerging. We performed a systematic review and metanalysis to study the efficacy of POEM in advanced achalasia cardia with sigmoid and megaesophagus. MethodsA literature search in PubMed and Embase was done from inception till August 3, 2021 to look for studies reporting exclusively on the role of POEM in advanced achalasia cardia with sigmoid and/or megaesophagus. The random effect method with inverse variance approach was used for the computation of pooled prevalence. For 2 groups' analysis of continuous outcome standardized mean difference was used as the summary measure. ResultsEleven studies with 428 patients were included for analysis. The pooled technical and clinical success was 98.27% (95% CI, 96.19-99.22; I 2 = 0%) and 89.38% (95% CI, 84.49-92.86; I 2 = 26%) and on subgroup analysis into sigmoid and megaesophagus it was (98.06% [95% CI, 95.41-99.19; I 2 = 0%], 98.47% [95% CI, 92.72-99.69; I 2 = 0%] and 87.92% [95% CI, 80.68-92.70; I 2 = 37%], 88.36% [95% CI, 62.62-97.17; I 2 = 77%]) respectively. The clinical success at < 1 year and 1-3 year follow-up was 89.37% (95% CI, 82.82-93.61; I 2 = 0%) and 88.66% (95% CI,; I 2 = 46%) respectively. There was a significant reduction in the post-POEM scores with standardized mean difference for Eckardt score (4.81), for integrated relaxation pressure at 4 seconds (1.93), and for lower esophageal sphincter pressure (2.06). ConclusionsPOEM is an effective modality of treatment even in the subset of patients of advanced achalasia cardia with sigmoid and megaesophagus.

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