PDF(Pubmed)
Abstract：
Background: The efficacy and safety of peroral endoscopic myotomy (POEM) in the treatment of sigmoid-type achalasia is unknown. This meta-analysis aims to explore the clinical outcomes of POEM for sigmoid-type achalasia. Method: We searched all relevant studies published up to September 2020 in PubMed, Embase, and Cochrane library databases. Meta-analyses for clinical success, Eckardt score, angle of esophageal tortuosity, diameter of esophagus, lower esophageal sphincter (LES) pressure, integrated relaxation pressure (IRP), adverse events, and gastroesophageal reflux diseases were performed based on random or fixed-effects models as needed. Results: We found a total of eight studies that provided data on 248 patients. Overall, the pooled clinical success was achieved in 211 sigmoid-type achalasia patients [90.4%; 95% confidence interval (CI), 85.5%-93.8%]. The pre- and post-POEM Eckardt scores, angle of esophageal tortuosity, diameter of esophageal, LES pressure, and IRP were significantly improved (All p < 0.05). The pooled adverse events rate was 13.0% (95% CI, 3.6%-37.4%). The pooled objective confirmation of reflux rate was 41.5% (95% CI, 26.5%-58.3%), and symptomatic reflux rate was 12.5% (95% CI, 8.3%-18.4%). Conclusions: Our current evidence indicated that POEM is an effective and safe therapeutic modality for the treatment of sigmoid-type achalasia.
摘要：
背景：经口内镜下肌切开术（POEM）治疗乙状结肠型门失弛缓症的疗效和安全性尚不清楚。本荟萃分析旨在探讨POEM治疗乙状结肠型门失弛缓症的临床疗效。方法：我们搜索了截至2020年9月在PubMed上发表的所有相关研究，Embase,和Cochrane图书馆数据库。临床成功的荟萃分析，Eckardt得分,食管弯曲角度，食道直径,食管下括约肌（LES）压力，综合松弛压力（IRP），不良事件,根据需要,根据随机或固定效应模型对胃食管反流病进行研究.结果：我们发现总共有8项研究提供了248例患者的数据。总的来说,211例乙状结肠型门失弛缓症患者获得了合并的临床成功[90.4%;95%置信区间(CI),85.5%-93.8%]。POEM之前和之后的Eckardt分数，食管弯曲角度，食管直径,LES压力,IRP明显改善(P均<0.05)。合并的不良事件率为13.0%（95%CI，3.6%-37.4%）。合并的反流率客观确认为41.5%（95%CI，26.5%-58.3%），症状反流率为12.5％（95％CI，8.3％-18.4％）。结论：我们目前的证据表明，POEM是治疗乙状结肠型门失弛缓症的一种有效且安全的治疗方式。
