Abstract：
Peroral endoscopic myotomy (POEM) achieves a satisfactory short-term clinical response in patients with achalasia. However, data on mid- and long-term clinical outcomes are limited. We aimed to assess the mid- and long-term efficacy and safety of POEM in achalasia patients.
Using the pre-designed search strategy, we identified relevant studies that evaluated the efficacy and safety of POEM with a minimum of 2-year follow-up in the Embase, Cochrane, and PubMed databases from inception to January 2021. Primary outcome was pooled mid- and long-term clinical success rate based on the Eckardt score. Secondary outcome was pooled long-term reflux-related adverse events.
A total of 21 studies involving 2,698 patients were included. Overall, the pooled clinical success rates with 2-, 3-, 4-, and 5-year follow-ups were 91.3% (95% confidence interval [CI] 88.4-93.6%), 90.4% (95% CI 88.1-92.2%), 89.8% (95% CI 83.6-93.9%), and 82.2% (95% CI 76.6-86.7%), respectively. Besides, the pooled long-term clinical success rates for type I, II, and III achalasia were 86.1% (95% CI 80.9-90.1%; I2 = 0%), 87.9% (95% CI 84.2-90.8%; I2 = 48.354%), and 83.9% (95% CI 72.5-91.2%; I2 = 0%), respectively. Moreover, the pooled incidence of symptomatic reflux and reflux esophagitis was 23.9% (95% CI 18.7-29.9%) and 16.7% (95% CI 11.9-23.1%), respectively.
POEM is associated with a long-term clinical success of 82.2% after 5 years of follow-up. Randomized control trials comparing POEM with laparoscopic Heller myotomy or pneumatic dilation with longer follow-up periods are needed to further demonstrate the long-term safety and efficacy of POEM.
Using the pre-designed search strategy, we identified relevant studies that evaluated the efficacy and safety of POEM with a minimum of 2-year follow-up in the Embase, Cochrane, and PubMed databases from inception to January 2021. Primary outcome was pooled mid- and long-term clinical success rate based on the Eckardt score. Secondary outcome was pooled long-term reflux-related adverse events.
A total of 21 studies involving 2,698 patients were included. Overall, the pooled clinical success rates with 2-, 3-, 4-, and 5-year follow-ups were 91.3% (95% confidence interval [CI] 88.4-93.6%), 90.4% (95% CI 88.1-92.2%), 89.8% (95% CI 83.6-93.9%), and 82.2% (95% CI 76.6-86.7%), respectively. Besides, the pooled long-term clinical success rates for type I, II, and III achalasia were 86.1% (95% CI 80.9-90.1%; I2 = 0%), 87.9% (95% CI 84.2-90.8%; I2 = 48.354%), and 83.9% (95% CI 72.5-91.2%; I2 = 0%), respectively. Moreover, the pooled incidence of symptomatic reflux and reflux esophagitis was 23.9% (95% CI 18.7-29.9%) and 16.7% (95% CI 11.9-23.1%), respectively.
POEM is associated with a long-term clinical success of 82.2% after 5 years of follow-up. Randomized control trials comparing POEM with laparoscopic Heller myotomy or pneumatic dilation with longer follow-up periods are needed to further demonstrate the long-term safety and efficacy of POEM.
摘要：
目的：经口内镜下肌切开术（POEM）对贲门失弛缓症患者的短期临床疗效满意。然而,关于中期和长期临床结局的数据有限.我们旨在评估POEM在门失弛缓症患者中的中长期疗效和安全性。
方法：使用预先设计的搜索策略，我们确定了相关研究，这些研究评估了POEM的有效性和安全性，并在Embase进行了至少2年的随访，科克伦,和PubMed数据库从成立到2021年1月。主要结局是基于Eckardt评分的中长期临床成功率。次要结果是汇集长期反流相关不良事件。
结果：共纳入21项研究，涉及2,698例患者。总的来说,合并的临床成功率与2-，3-,4-,5年随访率为91.3%(95%置信区间[CI]88.4-93.6%)，90.4%（95%CI88.1-92.2%），89.8%（95%CI83.6-93.9%），和82.2%（95%CI76.6-86.7%），分别。此外,合并的I型长期临床成功率，II,和III门失弛缓症为86.1％（95％CI80.9-90.1％；I2=0％），87.9%（95%CI84.2-90.8%；I2=48.354%），和83.9%（95%CI72.5-91.2%；I2=0%），分别。此外，症状性反流和反流性食管炎的合并发生率分别为23.9%(95%CI18.7-29.9%)和16.7%(95%CI11.9-23.1%),分别。
结论：POEM与5年随访后82.2%的长期临床成功率相关。需要将POEM与腹腔镜Heller肌切开术或气压扩张术进行比较，并进行更长的随访时间的随机对照试验，以进一步证明POEM的长期安全性和有效性。
方法：使用预先设计的搜索策略，我们确定了相关研究，这些研究评估了POEM的有效性和安全性，并在Embase进行了至少2年的随访，科克伦,和PubMed数据库从成立到2021年1月。主要结局是基于Eckardt评分的中长期临床成功率。次要结果是汇集长期反流相关不良事件。
结果：共纳入21项研究，涉及2,698例患者。总的来说,合并的临床成功率与2-，3-,4-,5年随访率为91.3%(95%置信区间[CI]88.4-93.6%)，90.4%（95%CI88.1-92.2%），89.8%（95%CI83.6-93.9%），和82.2%（95%CI76.6-86.7%），分别。此外,合并的I型长期临床成功率，II,和III门失弛缓症为86.1％（95％CI80.9-90.1％；I2=0％），87.9%（95%CI84.2-90.8%；I2=48.354%），和83.9%（95%CI72.5-91.2%；I2=0%），分别。此外，症状性反流和反流性食管炎的合并发生率分别为23.9%(95%CI18.7-29.9%)和16.7%(95%CI11.9-23.1%),分别。
结论：POEM与5年随访后82.2%的长期临床成功率相关。需要将POEM与腹腔镜Heller肌切开术或气压扩张术进行比较，并进行更长的随访时间的随机对照试验，以进一步证明POEM的长期安全性和有效性。
