Background: Peroral endoscopic myotomy (POEM) has been reported to be effective in achalasia patients with prior failed endoscopic intervention (PFI). We performed this meta-analysis to compare and summarize the clinical outcome of POEM in patients with or without prior endoscopic intervention. Method: We searched relevant studies published up to March 2020. Meta-analysis for technical success, clinical success, Eckardt score, lower esophageal sphincter (LES) pressure, clinical reflux, and adverse event were conducted based on a random-effects model. Results: Eight studies enrolling 1,797 patients who underwent POEM were enrolled, including 1,128 naïve achalasia patients and 669 patients with PFI. In the PFI group, the pooled estimated rate of technical success was 97.7% (95% confidence interval [CI], 95.8–98.8%), the pooled clinical success rate was 91.0% (95% CI, 88.0–93.4%), and the pooled adverse events rate was 23.5% (95% CI, 10.6–44.1%). The Eckardt score significantly decreased by 5.95 points (95% CI, 5.50–6.40, p #x3c; 0.00001) and the LES pressure significantly reduced by 19.74 mm Hg (95% CI, 14.10–25.39, p #x3c; 0.00001) in the PFI group. There were no difference in the technical success, clinical success, and adverse events rate between the treatment-naïve group and PFI group, with a risk ratio of 1.0 (95% CI, 0.99–1.01, p = 0.89), 1.02 (95% CI, 0.98–1.06, p = 0.36), and 0.88 (95% CI, 0.67–1.16, p = 0.38), respectively. Conclusions: POEM is an effective and safe treatment for achalasia patients with prior endoscopic intervention. Randomized clinical trials are needed to further verify the efficiency and safety of the POEM in those patients.
Dig Surg

中文翻译：

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经口内镜下肌切开术对既往内镜干预的贲门失弛缓症患者的影响：系统评价和荟萃分析

背景：据报道，经口内镜下肌切开术 (POEM) 对先前内镜干预 (PFI) 失败的贲门失弛缓症患者有效。我们进行了这项荟萃分析来比较和总结 POEM 在有或没有事先内窥镜干预的患者中的临床结果。方法：我们检索了截至 2020 年 3 月发表的相关研究。基于随机效应模型对技术成功、临床成功、Eckardt 评分、食管下括约肌 (LES) 压力、临床反流和不良事件进行 Meta 分析。结果：八项研究共纳入了 1,797 名接受 POEM 的患者，包括 1,128 名初治性贲门失弛缓症患者和 669 名 PFI 患者。在 PFI 组中，合并估计技术成功率为 97.7%（95% 置信区间 [CI]，95.8-98.8%），合并临床成功率为 91.0%（95% CI，88.0-93.4%），并且汇总的不良事件发生率为 23.5%（95% CI，10.6-44.1%）。Eckardt 评分显着降低 5.95 分（95% CI，5.50–6.40，p #x3c；0.00001），LES 压力显着降低 19.74 mm Hg（95% CI，14.10–25.39，p #x3c；0.00001） PFI 组。初治组和 PFI 组在技术成功、临床成功和不良事件发生率方面没有差异，风险比为 1.0（95% CI，0.99-1.01，p = 0.89)、1.02（95% CI，0.98–1.06，p = 0.36）和 0.88（95% CI，0.67–1.16，p = 0.38）。结论： POEM 是一种既往内镜介入治疗贲门失弛缓症患者的有效且安全的治疗方法。需要进行随机临床试验以进一步验证 POEM 在这些患者中的有效性和安全性。
挖掘手术