Safety and efficacy of POEM for treatment of achalasia: a systematic review of the literature
Safety and efficacy of POEM for treatment of achalasia: a systematic review of the literature
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DOI：
10.1007/s00464-016-5217-y
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发表时间：
2017-05-01
影响因子：
3.1
通讯作者：
Okrainec, Allan
中科院分区：
文献类型：
--
作者：
Crespin, Oscar M.;Liu, Louis W. C.;Okrainec, Allan
经口内镜下肌切开术（POEM）是一种新型的治疗贲门失弛缓症的方法，它结合了内镜和肌切开术的优点。本研究的目的是对文献进行系统评价，以评价POEM的有效性和安全性，系统评价按照PRISMA指南进行。循证医学评论、科克伦对照试验中心注册中心、奥维德MEDLINE（R），包括过程中和非索引引文，使用以下关键词检索POEM研究：食管失弛缓症、POEM、内窥镜检查、自然腔道手术、腹腔镜Heller肌切开术（LHM）和相关术语。Eckardt评分、下食管括约肌（LES）压力和报告的并发症是主要结局。两位作者独立审查了检索结果。第三位评审员解决了所有分歧。数据提取进行了试点测试，并得到所有作者的批准。为了确定是否可能使用Meta分析进行证据合成，对数据进行了临床、方法学和统计学异质性检查。在删除重复并应用排除标准后，选择了54项研究进行全文审查，其中共有19项研究被认为有资格进行进一步分析。共有10项回顾性研究和9项前瞻性研究，包括1299例POEM手术。未发现随机对照试验（RCT）。总体而言，POEM前后Eckardt评分和LES压力有显著差异。最常报告的并发症为粘膜穿孔、皮下气肿、气腹、气胸、肺气肿、胸腔积液和肺炎。中位随访时间为13个月（范围3-24），POEM是治疗贲门失弛缓症的安全有效的替代方法。然而，只有短期的后续数据相比，左手。需要RCT和长期随访研究来确定POEM治疗贲门失弛缓症患者的疗效和安全性。
Peroral endoscopic myotomy (POEM) is a novel intervention for the treatment of achalasia, which combines the advantages of endoscopic access and myotomy. The purpose of this study was to perform a systematic review of the literature to evaluate the efficacy and safety of POEM.The systematic review was conducted following the PRISMA guidelines. Evidence-Based Medicine Reviews, Cochrane Central Register of Controlled Trials, Ovid MEDLINE (R) including in-process and non-indexed citations were searched for POEM studies using the keywords: esophageal achalasia, POEM, endoscopy, natural orifice surgery, laparoscopic Heller myotomy (LHM), and related terms. Eckardt score, lower esophageal sphincter (LES) pressure, and reported complications were the main outcomes. Two authors reviewed the search result independently. A third reviewer resolved all disagreements. Data abstraction was pilot-tested and approved by all authors. Data were examined for clinical, methodological, and statistical heterogeneity with the aim of determining whether evidence synthesis using meta- analysis was possible.The search strategy retrieved 2894 citations. After removing duplicates and applying the exclusion criteria, 54 studies were selected for full-text review of which a total of 19 studies were considered eligible for further analysis. There were 10 retrospective and 9 prospective studies, including 1299 POEM procedures. No randomized control trial (RCT) was identified. Overall, the pre- and post-POEM Eckardt scores and LES pressure were significantly different. The most frequently reported complications were mucosal perforation, subcutaneous emphysema, pneumoperitoneum, pneumothorax, pneumomediastinum, pleural effusion, and pneumonia. The median follow-up was 13 months (range 3-24).POEM is a safe and effective alternative for the treatment of achalasia. However, only short-term follow-up data compared with LHM are available. RCTs and long-term follow-up studies are needed to establish the efficacy and safety of POEM in the management of patients with achalasia.