Clinical efficacy of per-oral endoscopic myotomy (POEM) for spastic esophageal disorders: a systematic review and meta-analysis

• Published in: Surgical endoscopy Vol. 34; no. 2; pp. 707 - 718
• Main Authors: Chandan, Saurabh, Mohan, Babu Pappu, Chandan, Ojasvini Choudhry, Jha, Lokesh Kumar, Mashiana, Harmeet Singh, Hewlett, Alexander Todd, Khashab, Mouen A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2020; Springer Nature B.V
• Subjects: Abdominal Surgery; Endoscopy; Esophageal diseases; Esophagus; Gastroenterology; Gynecology; Hepatology; Medicine; Medicine & Public Health; Meta-analysis; Proctology; Spasticity; Success; Surgery; Systematic review; Nutcracker esophagus; Esophageal motility; Achalasia; Diffuse esophageal spasm
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-019-06819-6

Background POEM has been successfully performed in patients with spastic esophageal disorders (SED), such as diffuse esophageal spasm, jackhammer esophagus, and type 3 achalasia. We performed a systematic review and meta-analysis to evaluate its efficacy in these patients and if total average myotomy length and prior medical or endoscopic treatments affected clinical success. Methods PubMed, EMBASE, Google-Scholar, Scopus, and Cochrane Review were searched for studies on POEM in SED from 2008 to September 2018. Clinical success was determined by Eckardt score (≤ 3) at follow-up. Sub-group analysis was performed based on myotomy length and evaluates the effect of prior treatments on clinical success. Results 9 studies with 210 patients were included in the final analysis. We found that the pooled rate of clinical success for POEM was 89.6% (95% CI 83.5–93.1, 95% PI 83.4–93.7, I 2  = 0%). In three studies (50 patients), where total myotomy length was < 10 cm, the pooled rate of clinical success was 91.1% (95% CI 79.5–96.4, I 2  = 0%). In six studies (160 patients), the length was > 10 cms and the pooled rate of clinical success was 89.1% (95% CI 83.0–93.2, I 2  = 0%). The difference between these results was not statistically significant ( p  = 0.69). Additionally, a meta-regression analysis showed that prior treatment status did not significantly affect the primary outcome ( p  = 0.43). Conclusions While it is well known that POEM is a safe and effective treatment for spastic esophageal disorders, we conclude that variation in total myotomy length and prior endoscopic or medical treatments did not have a significant effect on clinical success.