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. 2021 Jul 8:8:677694.
doi: 10.3389/fmed.2021.677694. eCollection 2021.

Efficacy and Safety of Peroral Endoscopic Myotomy for Sigmoid-Type Achalasia: A Systematic Review and Meta-Analysis

Jin Xu  1 , Chunyu Zhong  1 , Shu Huang  2 , Xinyi Zeng  1 , Shali Tan  1 , Lei Shi  1 , Yan Peng  1 , Muhan Lü  1 , Lianjun Ma  3 , Xiaowei Tang  1
Affiliations

Efficacy and Safety of Peroral Endoscopic Myotomy for Sigmoid-Type Achalasia: A Systematic Review and Meta-Analysis

Jin Xu et al. Front Med (Lausanne). .

Abstract

Background: The efficacy and safety of peroral endoscopic myotomy (POEM) in the treatment of sigmoid-type achalasia is unknown. This meta-analysis aims to explore the clinical outcomes of POEM for sigmoid-type achalasia. Method: We searched all relevant studies published up to September 2020 in PubMed, Embase, and Cochrane library databases. Meta-analyses for clinical success, Eckardt score, angle of esophageal tortuosity, diameter of esophagus, lower esophageal sphincter (LES) pressure, integrated relaxation pressure (IRP), adverse events, and gastroesophageal reflux diseases were performed based on random or fixed-effects models as needed. Results: We found a total of eight studies that provided data on 248 patients. Overall, the pooled clinical success was achieved in 211 sigmoid-type achalasia patients [90.4%; 95% confidence interval (CI), 85.5%-93.8%]. The pre- and post-POEM Eckardt scores, angle of esophageal tortuosity, diameter of esophageal, LES pressure, and IRP were significantly improved (All p < 0.05). The pooled adverse events rate was 13.0% (95% CI, 3.6%-37.4%). The pooled objective confirmation of reflux rate was 41.5% (95% CI, 26.5%-58.3%), and symptomatic reflux rate was 12.5% (95% CI, 8.3%-18.4%). Conclusions: Our current evidence indicated that POEM is an effective and safe therapeutic modality for the treatment of sigmoid-type achalasia.

Keywords: achalasia; meta-analysis; peroral endoscopic myotomy; sigmoid-type achalasia; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart.
Figure 2
Figure 2
Forest plot of clinical success of POEM for sigmoid-type achalasia.
Figure 3
Figure 3
(A) Meta-analysis of the changes in Eckardt score after POEM in sigmoid-type achalasia. (B) Meta-analysis of the changes in LES pressure after POEM in sigmoid-type achalasia. (C) Meta-analysis of the changes in IRP after POEM in sigmoid-type achalasia.
Figure 4
Figure 4
(A) Forest plot of adverse event rate of POEM for sigmoid-type achalasia. (B) Forest plot of rate of objective confirmation of reflux after POEM for sigmoid-type achalasia. (C) Forest plot of symptomatic reflux rate of POEM for sigmoid-type achalasia.
See this image and copyright information in PMC

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