Tu1157 COMPARISON OF OUTCOMES OF PERORAL ENDOSCOPIC MYOTOMY (POEM) IN ACHALASIA PATIENTS WITH OR WITHOUT PRIOR LAPROSCOPIC HELLER'S MYOTOMY (LHM)

Sanaka, Madhusudhan R.; Parikh, Malav P.; Thota, Prashanthi N.; Sarvepalli, Shashank; Gupta, Neena; Muthukuru, Sujit; Gabbard, Scott; Ray, Monica; Wadhwa, Neha; Murthy, Sudish C.; Raja, Siva

doi:10.1016/j.gie.2018.04.2187

Cited by 5 publications

(8 citation statements)

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“…The systematic search yielded 2595 references. After removal of duplicates and application of the inclusion/ exclusion criteria, 9 studies [13][14][15][16][17][18][19][20][21] were eligible for the qualitative and quantitative synthesis. Figure 1 depicts the details of the study selection, and general study characteristics are presented in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Among the 9 studies included, 3 prospective cohorts, 16,19,20 3 retrospective cohorts, 14,15,17 and 3 case series 13,18,21 were included. Six studies [14][15][16][17]19,20 compared the outcomes of POEM between patients with or without previous HM. Two multicenter studies 17,18 and 3 conference abstracts [19][20][21] with extractable data were identified.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Six studies [14][15][16][17]19,20 compared the outcomes of POEM between patients with or without previous HM. Two multicenter studies 17,18 and 3 conference abstracts [19][20][21] with extractable data were identified. A total of 272 patients (50% females, mean age, 54 years [95% CI, 53.7-54.4]) with a mean follow-up period of 15.6 months (95% CI, 14.5-16.7) were recruited in this review.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The weighted mean disease duration of patients was 9.3 years (95% CI, 9.0-9.6), and the mean interval between the previous HM and POEM was 8.2 years (95% CI, 8.0-8.4). Six studies 13,14,16,17,19,20 reported the presence of previous endoscopic treatments, including PD, botulinum toxin injection, and temporary esophageal stent placement. The rate of previous endoscopic treatments was 59.5%.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Shortterm relief was achieved in >90% of patients with no serious postoperative adverse events (AEs) observed. Since then, several studies [14][15][16][17][18][19][20][21] have explored the effect of POEM for patients with achalasia with previous HM. Considering the relatively small sample sizes and the potential clinical significance of these studies, we performed a systematic review and meta-analysis to evaluate the efficacy and safety of POEM in patients with achalasia with previous HM.…”

Section: Introductionmentioning

confidence: 99%

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Peroral endoscopic myotomy for patients with achalasia with previous Heller myotomy: a systematic review and meta-analysis

Huang

Chen

et al. 2021

Gastrointestinal Endoscopy

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Background and Aims: Heller myotomy (HM) is considered the standard surgical treatment for patients with achalasia. However, approximately 10% to 20% of patients with achalasia have persistent or recurrent symptoms after HM that require further therapy. Several studies have reported the outcomes of peroral endoscopic myotomy (POEM) in these patients. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of POEM in patients with achalasia with previous HM.Methods: An electronic literature search of PubMed, Embase, and the Cochrane Library was conducted up to January 31, 2020. Studies evaluating the outcomes of POEM in patients with achalasia with previous HM were eligible for inclusion. The primary outcomes were the pooled rates of clinical success (defined as post-POEM Eckardt score 3), mean change in Eckardt score, lower esophageal sphincter pressure, and integrated relaxation pressure (IRP). The secondary outcomes were procedure-related adverse events (AEs) and incidence of postoperative GERD.Results: A total of 9 studies involving 272 patients with achalasia were recruited in this review. POEM was successfully performed in 270 (99.3%) patients after previous HM. Clinical success was achieved in 90.0% (95% confidence interval [CI], 83.1%-96.8%) of patients. Eckardt score, lower esophageal sphincter pressure, and IRP were significantly lowered by 5.14 (95% CI, 4.19-6.09), 12.01 mm Hg (95% CI, 6.74-17.27), and 10.02 mm Hg (95% CI, 4.95-15.09), respectively. The pooled rates of postoperative symptomatic reflux, esophagitis, and abnormal pH monitoring were 36.9% (95% CI, 20.7%-53.1%), 33.0% (95% CI, 9.6%-56.4%), and 47.8% (95% CI, 33.4%-62.2%), respectively. Substantial heterogeneity was detected across all outcome measurements. Most of the AEs were self-limiting or managed conservatively.Conclusions: POEM is a safe and effective treatment for patients with achalasia with previous HM. Further data from prospective, controlled studies with long-term follow-up are needed to confirm these findings.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Peroral endoscopic myotomy for patients with achalasia with previous Heller myotomy: a systematic review and meta-analysis

Huang

Chen

et al. 2021

Gastrointestinal Endoscopy

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Esophageal Third Space Endoscopy: Recent Advances

Parikh

Gupta

Sanaka

2019

Curr Treat Options Gastro

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Obesity Does Not Impact Outcomes or Rates of Gastroesophageal Reflux After Peroral Endoscopic Myotomy in Achalasia

Sanaka¹,

Parikh²,

Subramanium³

et al. 2020

Journal of Clinical Gastroenterology

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Background: Outcomes of laparoscopic Heller myotomy in obese patients with achalasia are suboptimal along with the increased risk of gastroesophageal reflux disease (GERD). The impact of obesity on treatment success and GERD after peroral endoscopic myotomy (POEM) are not well known. Hence, our study aims were to compare the clinical outcomes and rates of GERD after POEM in nonobese versus obese patients with achalasia. Methods: Chart review of all achalasia patients who underwent POEM at our institution between April 2014 and June 2018. Patients with timed barium esophagram (TBE) and high-resolution esophageal manometry (HREM) before POEM along with post-POEM TBE, HREM, and esophageal pH study were included. Patients were categorized into 2 groups, nonobese (body mass index <30 kg/m2) and obese (body mass index ≥30 kg/m2). Patient demographics, TBE, HREM, pH study findings, and Eckardt scores were compared between the 2 groups. Results: A total of 89 patients (46 nonobese; 43 obese) met the study criteria. There were no significant differences in age, gender, achalasia subtype, operative time, length of stay and complication rates between the 2 groups. Treatment success (Eckardt score ≤3) was similar in both groups (97.7% nonobese vs. 92.7% obese, P=0.35). Abnormal DeMeester scores on pH study (>14.72) were similar in nonobese and obese patients (58.7% vs. 46.5%, P=0.25). Symptomatic GERD was also similar in both groups (17.8% in nonobese vs. 20% in obese, P=0.79). Conclusions: POEM is an equally safe and effective treatment option for both nonobese and obese patients with achalasia in the short-term. Interestingly, POEM does not lead to higher rates of GERD in obese compared with nonobese patients.

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Tu1157 COMPARISON OF OUTCOMES OF PERORAL ENDOSCOPIC MYOTOMY (POEM) IN ACHALASIA PATIENTS WITH OR WITHOUT PRIOR LAPROSCOPIC HELLER'S MYOTOMY (LHM)

Cited by 5 publications

References 0 publications

Peroral endoscopic myotomy for patients with achalasia with previous Heller myotomy: a systematic review and meta-analysis

Peroral endoscopic myotomy for patients with achalasia with previous Heller myotomy: a systematic review and meta-analysis

Esophageal Third Space Endoscopy: Recent Advances

Obesity Does Not Impact Outcomes or Rates of Gastroesophageal Reflux After Peroral Endoscopic Myotomy in Achalasia

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