Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Wang, Xuehong; Tan, Yuyong; Lv, Liang; Zhu, Hongyi; Chu, Yi; Li, Chenjie; Liu, Deliang

doi:10.17235/reed.2016.4488/2016

Cited by 25 publications

(27 citation statements)

References 30 publications

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“…In the elderly, on account of associated diseases, endoscopic treatment is used as the first line. The clinical success rate in our study for this subgroup was similar to the overall success rate [20,21].…”

Section: Discussionsupporting

confidence: 83%

POEM: Five Years of Experience in a Single East European Center

Tefas

Boroș²,

Ciobanu

et al. 2020

JGLD

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Background and Aims: Achalasia is an esophageal motility disorder with many available therapies. Peroral endoscopic myotomy (POEM) is a therapeutic alternative to surgical myotomy, harboring significant potential short term advantages. Our aim was to analyze a single-series POEM’s learning curve, safety and efficiency over short, medium and long-terms in an East European Center. Methods: This observational, prospective study was carried out in the Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. Patients with symptomatic achalasia (Eckardt score>3) and pre-op evaluations consistent with the diagnosis of achalasia were included. All POEMs were performed by a highly skilled endoscopist. All patients were allowed to eat 48 hours after POEM. An esophagography was performed in all patients to exclude any leakage. The patients were asked to return for follow-up at established intervals: 1 month, 6 months, 12 months, and annually thereafter. Results: 136 patients were included with an average duration of symptomatology of 36.75 months. The procedure was technically successful in all patients, while a clinical success rate was achieved in 87.5% (n=119) of patients after one POEM session. The success rate was 92.64% after 6 months, 91.17% after one year, 88.9% after 2 years, and 87.5% after 3 years or more; 12.5% of patients required additional treatment. Eighteen patients (13.23%) presented major early complications. Gastroesophageal reflux disease was encountered in 16 patients immediately after POEM and in 22 patients at subsequent follow-ups. Conclusion: POEM is a safe and effective minimally invasive therapeutic option which can substitute surgical myotomy, having a high success rate and a low rate of adverse events in short, medium and long-term.

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Section: Discussionsupporting

confidence: 83%

POEM: Five Years of Experience in a Single East European Center

Tefas

Boroș²,

Ciobanu

et al. 2020

JGLD

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“…748 records were screened, and 88 full-length articles were assessed. Sixty-six studies were included in the final analysis, four of which directly compared outcomes of POEM to PD [32,35,36,38] [35, 40, 68, 78, 79, 83 ,89]. Of the 66 included studies, 62 were cohort studies (30 retrospective and 32 prospective), three case series and one randomized controlled trial.…”

Section: Search Results and Population Characteristicsmentioning

confidence: 99%

“…The detailed assessment of study quality can be found in Supplementary Table 4. Overall, three studies [32,36,38] were considered high quality and the rest [12, 24-34, 36-42, 44, 46-56, 58-91] were considered of medium quality. There were no low-quality studies.…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

et al. 2021

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Background and study aims Peroral endoscopic myotomy (POEM) is increasingly being used as the preferred treatment option for achalasia. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of POEM versus pneumatic balloon dilation (PD). Methods We performed a comprehensive review of studies that reported clinical outcomes of POEM and PD for the treatment of achalasia. Measured outcomes included clinical success (improvement of symptoms based on a validated scale including an Eckardt score ≤ 3), adverse events, and post-treatment gastroesophageal reflux disease (GERD). Results Sixty-six studies (6268 patients) were included in the final analysis, of which 29 studies (2919 patients) reported on POEM and 33 studies (3050 patients) reported on PD and 4 studies (299 patients) compared POEM versus PD. Clinical success with POEM was superior to PD at 12, 24, and 36 months (92.9 %, vs 76.9 % P = 0.001; 90.6 % vs 74.8 %, P = 0.004; 88.4 % vs 72.2 %, P = 0.006, respectively). POEM was superior to PD in type I, II and III achalasia (92.7 % vs 61 %, P = 0.01; 92.3 % vs 80.3 %, P = 0.01; 92.3 %v 41.9 %, P = 0.01 respectively)Pooled OR of clinical success at 12 and 24 months were significantly higher with POEM (8.97; P = 0.001 & 5.64; P = 0.006). Pooled OR of GERD was significantly higher with POEM (by symptoms: 2.95, P = 0.02 and by endoscopic findings: 6.98, P = 0.001). Rates of esophageal perforation (0.3 % vs 0.6 %, P = 0.8) and significant bleeding (0.4 % vs 0.7 %, P = 0.56) were comparable between POEM and PD groups. Conclusions POEM is more efficacious than PD in the treatment of patients with achalasia during short-term and long-term follow-up, albeit with higher risk of abnormal esophageal acid exposure.

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“…Wang et al . compared the efficacy of POEM and pneumatic balloon dilatation in patients older than 65 years . In this group, the efficacy of these two procedures was 92.2% and 80.0% (success defined as an ES of ≤3), respectively, without any major complications …”

Section: Clinical Questions and Statementsmentioning

confidence: 99%

Clinical practice guidelines for peroral endoscopic myotomy

Inoue

Shiwaku

Iwakiri

et al. 2018

Digestive Endoscopy

131

155

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Peroral endoscopic myotomy (POEM) is a novel clinical technique developed in Japan used to treat esophageal achalasia and esophageal motility disorders. This technique has been rapidly accepted and widely disseminated throughout our clinical practice because of its low invasiveness, technical novelty, and high efficacy. Since the advent of POEM, there have been no clinical guidelines that clearly indicated its standard of care, and these guidelines have been anticipated both nationally and internationally by clinicians who engage in POEM practice. In 2017, to meet these needs, the Japan Gastroenterological Endoscopy Society (JGES) launched the guideline committee for POEM. Based on the guideline development process proposed by the Medical Information Network Distribution Service (MINDS), the guideline committee initially created research questions on POEM and conducted a systematic review and meta-analysis on each topic. The clinical research extracted from databases for these clinical questions and the systematic review mainly comprised a few retrospective studies with a small number of participants and short trial periods; hence, the strength of the evidence and recommendations derived from these results was low. Throughout this process, the guideline committee met thrice: once on May 13, 2017, and again on September 17, 2017, to formulate the draft. A consensus meeting was then held on January 14, 2018, in Tokyo to establish the guideline statements and finalize the recommendations using the modified Delphi method. This manuscript presents clinical guidelines regarding current standards of practice and recommendations in terms of the nine chief topics in POEM.

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Peroral endoscopic myotomy versus pneumatic dilation for achalasia in patients aged = 65 years

Cited by 25 publications

References 30 publications

POEM: Five Years of Experience in a Single East European Center

POEM: Five Years of Experience in a Single East European Center

Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

Clinical practice guidelines for peroral endoscopic myotomy

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