Peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy produce a similar short-term anatomic and functional effect

Teitelbaum, Ezra N.; Rajeswaran, Shankar; Zhang, Raymond; Sieberg, Ryan T.; Miller, Frank H.; Soper, Nathaniel J.; Hungness, Eric S.

doi:10.1016/j.surg.2013.04.051

Cited by 73 publications

(33 citation statements)

References 23 publications

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“…The included retrospective case–control studies concerned different cohorts of patients published between 2013 and 2015, except for 2 studies 21,24 in which the same group may overlap. The total number of included patients was 486 (196 in POEM group and 290 in LHM group) ranging from 8 to 180 patients per study.…”

Section: Resultsmentioning

confidence: 99%

Surgery or Peroral Esophageal Myotomy for Achalasia

et al. 2016

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To date very few studies with small sample size have compared peroral esophageal myotomy (POEM) with the current surgical standard of care, laparoscopic Heller myotomy (LHM), in terms of efficacy and safety, and no recommendations have been proposed.To investigate the efficacy and safety of POEM compared with LHM, for the treatment of achalasia.The databases of Pubmed, Medline, Cochrane, and Ovid were systematically searched between January 1, 2005 and January 31, 2015, with the medical subject headings (MeSH) and keywords “achalasia,” “POEM,” “per oral endoscopic myotomy,” and “peroral endoscopic myotomy,” “laparoscopic Heller myotomy” (LHM), “Heller myotomy.”All types of study designs including adult patients with diagnosis of achalasia were selected. Studies that did not report the comparison between endoscopic and surgical treatment, experimental studies in animal models, single case reports, technical reports, reviews, abstracts, and editorials were excluded.The total number of included patients was 486 (196 in POEM group and 290 in LHM group).There were no differences between POEM and LHM in reduction in Eckardt score (MD = −0.659, 95% CI: −1.70 to 0.38, P = 0.217), operative time (MD = −0.354, 95% CI: −1.12 to 0.41, P = 0.36), postoperative pain scores (MD = −1.86, 95% CI: −5.17 to 1.44, P = 0.268), analgesic requirements (MD = −0.74, 95% CI: −2.65 to 1.16, P = 0.445), and complications (OR = 1.11, 95% CI: 0.5–2.44, P = 0.796). Length of hospital stay was significantly lower for POEM (MD = −0.629, 95% CI: −1.256 to −0.002, P = 0.049). There was a trend toward significant reduction in symptomatic gastroesophageal reflux rate in favors of LHM compared to POEM group (OR = 1.81, 95% CI: 1.11–2.95, P = 0.017).All included studied were not randomized. Furthermore all selected studies did not report the results of follow-up longer than 1 year and most of them included patients who were both treatment naive and underwent previous endoscopic or surgical interventions for achalasia.POEM represents a safe and efficacy procedure comparable to the safety profile of LHM for achalasia at a short-term follow-up. Long-term clinical trials are urgently needed.

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Section: Resultsmentioning

confidence: 99%

Surgery or Peroral Esophageal Myotomy for Achalasia

et al. 2016

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“…Peroral endoscopic myotomy does not include an anti-reflux procedure; thus, significant attention has been paid to the diagnosis, incidence, and management of reflux in order to better compare and contrast it with the gold standard. Short-term data suggest that POEM is as effective as LHM in treating dysphagia with similar rates of postoperative reflux although randomized controlled trials have yet to be performed [17][18][19]. In cohort studies, postoperative reflux is reported in 0-53 % of patients following POEM [6][7][8][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Gastroesophageal reflux symptoms do not correlate with objective pH testing after peroral endoscopic myotomy

et al. 2015

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“…Small, retrospective series suggest that POEM and LHM have similar short-term efficacy and safety (Tables 7-10). 19,51,55,57,58 High-quality comparative data from prospective, randomized, controlled trials comparing POEM to pneumatic dilation and LHM would be valuable, and such multicenter trials are underway in Europe. In the United States, given the rapid adoption of POEM by both physicians and patients, its minimal invasiveness, the fact that it essentially represents a Heller myotomy by a per-oral route, and the uniformly excellent outcomes on prospective series now totaling close to 1000 patients worldwide, it will be increasingly difficult to enroll patients in randomized trials, particularly those that include LHM.…”

Section: Future Perspectives On Poemmentioning

confidence: 99%