PDF(Pubmed)
Abstract：
Background: Heller myotomy has been considered the standard surgical treatment for patients with achalasia. Since the initiation of peroral endoscopic myotomy (POEM), it has represented an alternative for treating patients with achalasia. Over the years, numerous prospective and retrospective studies with POEM use for achalasia have been published. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of POEM in patients with achalasia. Methods: Publications investigating the safety and efficacy of POEM in patients with achalasia were searched in Medline, Ovid Journals, Medline non-indexed citations, and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Pooling was conducted by both fixed and random effects models. Results: The initial search identified 328 reference articles; of these, 34 relevant articles were selected and reviewed. Data was extracted from 20 studies (n=1753) which met the inclusion criteria. In pooled analysis, the clinical success of POEM at 3 months was 94% (95% CI=93-95). The pooled clinical success of POEM at 12 months was 91% (95% CI=90-92). The pooled rate of gastroesophageal reflux disease (GERD) was 21% (95% CI=19-23), esophagitis was reported in 16% (95% CI=15-18), pneumomediastinum in 4% (95% CI=3-6), cervical emphysema in 12% (95% CI=10-13), pneumoperitoneum in 8% (95% CI=7-10), pneumothorax in 5% (95% CI=4 - 6), pleural effusion in 3% (95% CI=2-3), post-operative bleeding in 4.29% (95% CI=1.91 -7.61) and aspiration pneumonia in 3.08% (95% CI=1.13-5.97) of the patients after POEM. Conclusion: This meta-analysis suggests that POEM is a highly effective and safe endoscopic treatment for patients with achalasia and a reasonable alternative to Heller myotomy.
摘要：
背景：Heller肌切开术被认为是贲门失弛缓症患者的标准手术治疗方法。自从经口内镜肌切开术（POEM）开始以来，它代表了一种治疗贲门失弛缓症患者的替代方法。多年来,已经发表了许多关于POEM用于贲门失弛缓症的前瞻性和回顾性研究。我们进行了系统评价和荟萃分析，以评估POEM在贲门失弛缓症患者中的疗效和安全性。方法：在Medline搜索有关POEM在贲门失弛缓症患者中的安全性和有效性的出版物，Ovid期刊,Medline非索引引文，和Cochrane中央对照试验登记册和系统评价数据库。通过固定效应模型和随机效应模型进行汇集。结果：最初的搜索确定了328篇参考文章；其中，选择并回顾了34篇相关文章。数据来自20项符合纳入标准的研究(n=1753)。在汇总分析中，POEM在3个月时的临床成功率为94%(95%CI=93~95).POEM在12个月的合并临床成功率为91%(95%CI=90-92)。胃食管反流病（GERD）的合并率为21％（95％CI=19-23），据报道，16％的食管炎（95％CI=15-18），4%的纵隔肺炎（95%CI=3-6），12％的宫颈气肿（95％CI=10-13），8％的气腹（95％CI=7-10），5%的气胸（95%CI=4-6），3％的胸腔积液（95％CI=2-3），术后出血占4.29%（95%CI=1.91-7.61），吸入性肺炎占3.08%（95%CI=1.13-5.97）。结论：这项荟萃分析表明，POEM是一种高度有效和安全的内镜治疗贲门失弛缓症患者的方法，是一种合理的替代Heller肌切开术的方法。
