An Updated Meta-analysis: Similar Clinical Efficacy of Anterior and Posterior Approaches in Peroral Endoscopic Myotomy (POEM) for Achalasia

IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Gastroenterology Research and Practice Pub Date : 2022-04-11 DOI:10.1155/2022/8357588
Weina Jing, Xinyue Luo, Jin-lin Yang, Junchao Wu, Yuxiang Chen, Kai Deng
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引用次数: 1

Abstract

Introduction Currently, there are few studies on the efficacy of peroral endoscopic myotomy (POEM) in the anterior or posterior approach; however, limited studies have shown contradictory findings. Thus, the goal was to obtain more quantitative and objective outcomes and further compare the clinical efficacy of these two approaches in this meta-analysis. Methods A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to find studies relevant to POEM. The retrieval time was from database inception to September 2021. Studies reporting the effects of POEM according to the anterior or posterior approach were included. STATA 16.0 was used to perform statistical analysis, mainly comparing the quantitative objective indicators (lower esophageal sphincter (LES) pressure and Eckardt scores, etc.) in anterior and posterior approaches by meta-analysis. Result A total of 19 studies with 1261 patients were finally included. Except for shorter procedure time in the posterior approach, other factors (pooled difference of LES pressure, Eckardt scores, clinical success, length of total myotomy, hospital stays, gastroesophageal reflux (GERD), and adverse event) were compared, and all above confirmed that there is no difference between anterior and posterior approaches, and the safety of POEM is ensured. In addition, both anterior and posterior myotomy can improve LES pressure and Eckardt scores, and the difference in anterior and posterior myotomy was unconspicuous. Conclusion The terms of the pooled difference in LES pressure, Eckardt scores, and other factors (clinical success, length of total myotomy, hospital stays, GERD, adverse events, and procedure time) seemed to be similar for the anterior and posterior approaches. However, the further prognosis after POEM via anterior and posterior approaches needs to be answered in the future.
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一项最新的荟萃分析:经口内镜下肌切开术(POEM)前后入路治疗贲门失弛缓症的临床疗效相似
目前,关于经口内窥镜下肌切开术(POEM)在前、后入路中的疗效研究较少;然而,有限的研究显示出矛盾的结果。因此,本荟萃分析的目的是获得更多定量和客观的结果,并进一步比较这两种方法的临床疗效。方法综合检索PubMed、Embase、Cochrane Library和Web of Science,查找与POEM相关的研究。检索时间为数据库建立至2021年9月。包括了根据前路或后路报道POEM效果的研究。采用STATA 16.0进行统计分析,主要对前后入路的定量客观指标(食管下括约肌(LES)压力、Eckardt评分等)进行meta分析比较。结果共纳入19项研究,1261例患者。除后路手术时间较短外,比较其他因素(LES压、Eckardt评分、临床成功、全肌切开术时间、住院时间、胃食管反流(GERD)、不良事件),均证实前后路无差异,保证了POEM的安全性。此外,前后肌切开术均可改善LES压和Eckardt评分,且前后肌切开术差异不显著。结论前后入路的LES压、Eckardt评分和其他因素(临床成功、全肌切开术时间、住院时间、反流、不良事件和手术时间)的综合差异似乎相似。然而,经前后路行POEM后的进一步预后需要在未来回答。
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来源期刊
Gastroenterology Research and Practice
Gastroenterology Research and Practice GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.40
自引率
0.00%
发文量
91
审稿时长
1 months
期刊介绍: Gastroenterology Research and Practice is a peer-reviewed, Open Access journal which publishes original research articles, review articles and clinical studies based on all areas of gastroenterology, hepatology, pancreas and biliary, and related cancers. The journal welcomes submissions on the physiology, pathophysiology, etiology, diagnosis and therapy of gastrointestinal diseases. The aim of the journal is to provide cutting edge research related to the field of gastroenterology, as well as digestive diseases and disorders. Topics of interest include: Management of pancreatic diseases Third space endoscopy Endoscopic resection Therapeutic endoscopy Therapeutic endosonography.
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