Outcome of peroral endoscopic myotomy (POEM) in treatment-naive patients. A systematic review

Abstract

Objectives. Achalasia is a primary motility disorder of the esophagus characterized by aperistalsis and failure of lower esophageal sphincter (LES) relaxation. Treatment of achalasia aims at reducing LES pressure. The common treatment modalities are laparoscopic Heller myotomy and pneumatic dilatation, but during the last decade, a promising treatment, per oral endoscopic myotomy (POEM), has been introduced. The aim of the present study was to perform a systematic review of the literature to assess the outcome of POEM in treatmentnaive patients. Materials and Methods. A systematic literature search in PubMed, Embase and Cochrane databases was performed using the terms 'Achalasia AND (POEM OR peroral endoscopic myotomy OR per-oral endoscopic myotomy)'. Inclusion criteria were: original article; English language; n ≥ 20 with ≥ 90 % treatment-naive patients; follow-up ≥ 3 months; and outcome evaluation of POEM including symptom score and objective tests. Exclusion criteria were: reviews and metaanalyses; pediatric data; duplicates; and articles with overlapping data material. Results. Of the 1641 articles identified, seven were included. The included studies all reported a short term clinical success of > 90%. Clinical success including post POEM reflux was mainly estimated by symptom scorings. There were few procedure-related complications. Conclusions. The studies of treatment-naive patients indicate a high rate of clinical success. Nevertheless, a more systematic and standardized evaluation is recommended to improve the reports on outcome of POEM. The follow-up rate should be high and the evaluation protocol should include both symptom scoring and objective testing with predefined treatment goals.

Quality of Life Following Peroral Endoscopic Myotomy for Esophageal Achalasia: A Systematic Review and Meta-Analysis

“…The meta-analysis of Barbieri et al and Evensen et al showed that the pooled technical and clinical success of POEM for treatment achalasia was more than 90%. 4,28) In addition to the excellent clinical outcomes, this novel endoscopic approach has also been reported to improve the QoL in achalasia patients during follow-up. [6][7][8][9][10][11][12] However, there has been no meta-analysis to review the effect of POEM to QoL for patients.…”

“…Presently, laparoscopic Heller myotomy (LHM), pneumatic dilatation, and peroral endoscopic myotomy (POEM) have been regarded as the most effective methods for achalasia. 4) LHM is considered the gold standard in achalasia treatment since it provides superior and long-lasting symptom relief for patients. 5) However, with the development of endoscopic technique, POEM procedure, which is less invasive than LHM, has been becoming the first choice for more doctors and patients.…”

Esophageal POEM: the new standard of care

“…In a recent metaanalysis of 36 studies and 2,373 patients, Akintoye et al reported that POEM achieved clinical success, defined by an Eckardt score ≤3, in 98% of the patients (95% CI, 97-100%) with sustained response at 12-month followup (28). Other comprehensive systemic reviews and metaanalysis have further confirmed similar clinical efficacy based on subjective and objective parameters, with significant decreases in Eckardt scores, lower esophageal sphincter (LES) pressures, and barium retention rates on esophagrams (29)(30)(31)(32).…”

The Asian Pacific Association for the Study of the Liver clinical practice guidance: the diagnosis and management of patients with autoimmune hepatitis

“…Renal function remained stable in most of the patients, thus demonstrating the efficacy of tacrolimus in patients with AIH with minimal side effects. Tacrolimus can be a potential treatment option for patients with AIH refractory to standard therapy [ 306 ]. In another study, with 17 refractory patients, the majority of patients achieved biochemical and immunological response with tacrolimus therapy in first year of therapy.…”