Peroral endoscopic myotomy is safe and effective in achalasia patients aged older than 60 years compared with younger patients

Tang, Xiaowei; Ren, Yun; Gao, Qiaoping; Huang, Silin; Zhou, Jieqiong; Zhang, Xiaofeng; Yang, Jianfeng; Wei, Zhengjie; Chen, Zhenyu; Jiang, Bo; Gong, Wei

doi:10.1111/ggi.13083

Cited by 19 publications

(15 citation statements)

References 30 publications

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“…748 records were screened, and 88 full-length articles were assessed. Sixty-six studies 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 were included in the final analysis, four of which directly compared outcomes of POEM to PD 32 35 36 38 . A total of 29 studies reported on the outcomes of POEM 24 …”

Section: Resultsmentioning

confidence: 99%

Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

et al. 2021

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Background and study aims Peroral endoscopic myotomy (POEM) is increasingly being used as the preferred treatment option for achalasia. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of POEM versus pneumatic balloon dilation (PD). Methods We performed a comprehensive review of studies that reported clinical outcomes of POEM and PD for the treatment of achalasia. Measured outcomes included clinical success (improvement of symptoms based on a validated scale including an Eckardt score ≤ 3), adverse events, and post-treatment gastroesophageal reflux disease (GERD). Results Sixty-six studies (6268 patients) were included in the final analysis, of which 29 studies (2919 patients) reported on POEM and 33 studies (3050 patients) reported on PD and 4 studies (299 patients) compared POEM versus PD. Clinical success with POEM was superior to PD at 12, 24, and 36 months (92.9 %, vs 76.9 % P = 0.001; 90.6 % vs 74.8 %, P = 0.004; 88.4 % vs 72.2 %, P = 0.006, respectively). POEM was superior to PD in type I, II and III achalasia (92.7 % vs 61 %, P = 0.01; 92.3 % vs 80.3 %, P = 0.01; 92.3 %v 41.9 %, P = 0.01 respectively)Pooled OR of clinical success at 12 and 24 months were significantly higher with POEM (8.97; P = 0.001 & 5.64; P = 0.006). Pooled OR of GERD was significantly higher with POEM (by symptoms: 2.95, P = 0.02 and by endoscopic findings: 6.98, P = 0.001). Rates of esophageal perforation (0.3 % vs 0.6 %, P = 0.8) and significant bleeding (0.4 % vs 0.7 %, P = 0.56) were comparable between POEM and PD groups. Conclusions POEM is more efficacious than PD in the treatment of patients with achalasia during short-term and long-term follow-up, albeit with higher risk of abnormal esophageal acid exposure.

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Section: Resultsmentioning

confidence: 99%

Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

et al. 2021

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“…Peroral endoscopic myotomy for EMD is minimally invasive and has a high success rate in elderly patients 7 . Thus, clinical practice guidelines for POEM from JGES 15 state that POEM is a safe and effective procedure for elderly patients as an answer to the clinical question regarding the effectiveness of POEM in treating elderly patients with esophageal achalasia.…”

Section: Discussionmentioning

confidence: 99%

“…Peroral endoscopic myotomy is considered as one of the useful therapeutic options for the elderly with EMD because of its minimal invasiveness and effectiveness. The comparison of the safety and efficacy of POEM for EMD in adults aged 60 years and above and adults under 60 years has already been reported 7 . Studies on EMD in adults aged 80 years and above have been limited to descriptive data collected in an international multicenter study about the safety and efficacy of POEM 8 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of the safety and efficacy of peroral endoscopic myotomy between octogenarians and non‐octogenarians

Abe

Tanaka

Kawara³

et al. 2020

Digestive Endoscopy

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This study compared the safety and efficacy of peroral endoscopic myotomy for esophageal motility disorders between octogenarians and non-octogenarians. Methods: This retrospective observational study recruited 321 patients (28 octogenarians and 293 non-octogenarians) who underwent peroral endoscopic myotomy from two institutions. Clinical success (postoperative Eckardt score ≤ 3), technical success (completion of gastric and esophageal myotomy), and perioperative adverse events were compared between octogenarians and non-octogenarians. Perioperative adverse events were classified into major and minor adverse events based on the International Peroral Endoscopic Myotomy Survey criteria and were subdivided into technical and nontechnical adverse events according to the presence of a direct causal relationship with the procedure. Results: There were no significant differences in the rates of clinical success 1 year after treatment (100% vs. 97.3%, P = 0.64) and technical success (100% vs. 99.7%, P = 0.91) between octogenarians and non-octogenarians. Octogenarians had a higher incidence of perioperative adverse events (28.6% vs. 10.2%, P = 0.00097), particularly major adverse events (25.0% vs. 3.0%, P < 0.0001). There were no significant differences in the incidence of minor adverse events (7.1% vs. 7.9%, P = 0.67). Although there was no difference in the incidence of technical adverse events (10.7% vs. 9.2%, P = 0.74), octogenarians had a significantly higher incidence of non-technical adverse events (17.9% vs. 1.0%, P = 0.0002). Conclusions: There were no significant differences in shortterm clinical success and technical success between octogenarians and non-octogenarians. However, octogenarians showed a significantly higher incidence of perioperative adverse events, particularly in major adverse events and nontechnical adverse events. Peroral endoscopic myotomy for octogenarians should be carefully applied.

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“…retrospectively analyzed their data regarding the efficacy of POEM in 18 patients older than 60 years and in 95 patients younger than 60 years, they found that efficacy was 92.9% and 89.9% (success defined as an ES of ≤3), respectively, with no statistically significant differences between them. There was also no statistically significant difference in the rate of adverse events in both groups . Wang et al .…”

Section: Clinical Questions and Statementsmentioning

confidence: 99%

Clinical practice guidelines for peroral endoscopic myotomy

Inoue

Shiwaku

Iwakiri

et al. 2018

Digestive Endoscopy

127

155

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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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Peroral endoscopic myotomy is safe and effective in achalasia patients aged older than 60 years compared with younger patients

Abstract: As well as in younger patients, POEM can be safely carried out in elderly patients, providing significant symptom relief. POEM might be recommended as the first therapeutic approach to elderly achalasia patients. Geriatr Gerontol Int 2017; 17: 2407-2413.

Cited by 19 publications

References 30 publications

Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

Comparison of the safety and efficacy of peroral endoscopic myotomy between octogenarians and non‐octogenarians

Clinical practice guidelines for peroral endoscopic myotomy

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