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Endoscopy 2016; 48(12): 1059-1068
DOI: 10.1055/s-0042-114426
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Peroral endoscopic myotomy: a meta-analysis

Emmanuel Akintoye
1   Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States
,
Nitin Kumar
2   Developmental Endoscopy Lab, Brigham and Women’s Hospital, Boston, Massachusetts, United States
,
Itegbemie Obaitan
3   Brigham and Women’s Hospital, Boston, Massachusetts, United States
,
Quazim A. Alayo
4   Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
Christopher C. Thompson
5   Division of Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
› Author Affiliations
Further Information

Publication History

submitted14 January 2016

accepted after revision06 July 2016

Publication Date:
12 September 2016 (online)

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Background and study aim: Peroral endoscopic myotomy (POEM) is a relatively novel minimally invasive technique that is used to treat achalasia and other esophageal motility disorders. We systematically reviewed the medical literature in order to evaluate the safety and efficacy of POEM.

Methods: We performed a comprehensive review and meta-analysis of studies published up to March 2016 that reported on clinical outcomes of POEM. Five databases were searched: MEDLINE, EMBASE, Ovid, CINAHL, and Cochrane.

Results: A total of 36 studies involving 2373 patients were included in the review. Clinical success (Eckardt score ≤ 3) was achieved in 98 % (95 % confidence interval [CI] 97 % – 100 %) of patients after the procedure. The mean Eckardt score decreased from 6.9 ± 0.15 preoperatively to 0.77 ± 0.10, 1.0 ± 0.10, and 1.0 ± 0.08 within 1, 6, and 12 months of treatment. In addition, there were significant decreases in the average lower esophageal sphincter pressure, integrated relaxation pressure, and the average heights of the barium column following a timed barium esophagogram after the procedure. After a mean follow-up of 8 months post-procedure, the rates of symptomatic gastroesophageal reflux, esophagitis on esophagogastroduodenoscopy, and abnormal acid exposure were 8.5 % (95 %CI 4.9 % – 13 %), 13 % (95 %CI 5.0 % – 23 %), and 47 % (95 %CI 21 % – 74 %), respectively.

Conclusions: POEM appears to be safe and effective based on the large body of current evidence, and warrants consideration as first-line therapy when an expert operator is available.

Table e1, Fig. e4, e5

 

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