Role of Peroral Endoscopic Myotomy in Advanced Achalasia Cardia With Sigmoid and/or Megaesophagus: A Systematic Review and Metanalysis

Abstract

Background/AimsSigmoid esophagus and/or megaesophagus are considered as an advanced stage in the natural history of achalasia cardia. The role of peroral endoscopic myotomy (POEM) in these subset of patients is emerging. We performed a systematic review and metanalysis to study the efficacy of POEM in advanced achalasia cardia with sigmoid and megaesophagus. MethodsA literature search in PubMed and Embase was done from inception till August 3, 2021 to look for studies reporting exclusively on the role of POEM in advanced achalasia cardia with sigmoid and/or megaesophagus. The random effect method with inverse variance approach was used for the computation of pooled prevalence. For 2 groups' analysis of continuous outcome standardized mean difference was used as the summary measure. ResultsEleven studies with 428 patients were included for analysis. The pooled technical and clinical success was 98.27% (95% CI, 96.19-99.22; I 2 = 0%) and 89.38% (95% CI, 84.49-92.86; I 2 = 26%) and on subgroup analysis into sigmoid and megaesophagus it was (98.06% [95% CI, 95.41-99.19; I 2 = 0%], 98.47% [95% CI, 92.72-99.69; I 2 = 0%] and 87.92% [95% CI, 80.68-92.70; I 2 = 37%], 88.36% [95% CI, 62.62-97.17; I 2 = 77%]) respectively. The clinical success at < 1 year and 1-3 year follow-up was 89.37% (95% CI, 82.82-93.61; I 2 = 0%) and 88.66% (95% CI,; I 2 = 46%) respectively. There was a significant reduction in the post-POEM scores with standardized mean difference for Eckardt score (4.81), for integrated relaxation pressure at 4 seconds (1.93), and for lower esophageal sphincter pressure (2.06). ConclusionsPOEM is an effective modality of treatment even in the subset of patients of advanced achalasia cardia with sigmoid and megaesophagus.

Nearest and ling-time outcomes of endoscopic treatment of patients with esophageal achalasia

“…ПОЭМ может быть выполнен при при любом типе ахалазии в том числе при его S-образной деформации (IV стадия по классификации Б. В. Петровского) [5,12,19,20]. При этом технический успех операции и клиническое улучшение возникает более чем у 85% пациентов.…”

A bibliometric analysis of peroral endoscopic myotomy for achalasia: Where have we been and where should we go next?

“…POEM provides more effective and long-lasting relief for type III achalasia and should be considered a first-line treatment for this challenging sub-type [39,40]. In addition, POEM has good clinical efficacy and morphological improvement in treating patients with advanced achalasia With Sigmoid or Megaesophagus [41,42]. Furthermore, prior PD and LHM may make subsequent POEM treatment more challenging, but it does not impede successful POEM implementation and the safety and efficacy of achalasia patients [43,44].…”

Management of End-Stage Achalasia

“…d. POEM is technically feasible option, but clinical success is less compared to common achalasia patients. e. A systematic review from 2022 65 concluded that POEM appears to be an effective modality of treatment for advanced sigmoid or megaesophagus achalasia, but a very high incidence of reflux esophagitis is seen already less than 2 years after procedure. It seems that they did not give any importance to this complication that may produce severe adverse effects.…”