Abstract
Sa1277 POEM AS SALVAGE THERAPY FOR ACHALASIA AFTER FAILED ENDOSCOPIC OR SURGICAL THERAPY IS TECHNICALLY FEASIBLE AND SAFE - A SYSTEMATIC REVIEW AND META-ANALYSIS
Gastrointestinal endoscopy, Vol.89(6 Supplement), pp.AB201-AB201
06/2019
DOI: 10.1016/j.gie.2019.03.167
Abstract
Backgrounds and Aims
Per oral endoscopic myotomy (POEM) has been reported as an effective and safe salvage therapeutic option for patients who had failed responses to the conventional endoscopic or surgical therapy but there is limited composite data. We performed a systematic review and meta-analysis of studies that reported the rate of technical success and the rate of adverse events among patients who underwent POEM after failed endoscopic or surgical therapy.
Methods
MEDLINE and EMBASE databases were searched from inception through August 31, 2018 for articles or abstracts reporting the efficacy and safety of POEM after failed endoscopic or surgical therapy. Two authors independently screened all titles and abstracts to select studies of interest and the full paper version was reviewed for selected studies. Primary outcomes included the pooled estimated rates of technical success and procedural time. Technical success was defined as the improvement of symptoms and a decrease in Eckardt score to ≤3 after POEM. Secondary outcomes were the rates of post-procedural bleeding, symptomatic pneumoperitoneum, and POEM related GERD. A random-effects model was used to determine pooled proportions of technical success and complication rates. Heterogeneity was assessed using the I2 statistic. Publication bias was visually inspected by using a funnel plot and by the Begg’s and Egger’s tests.
Results
We identified 12 studies reporting on 259 patients that met our criteria. Pooled estimated rates of technical success was 90.0% (95% CI, 76.0% - 96.0%) and mean procedural time was 88 minutes (95% CI, 71 minutes -104 minutes). High heterogeneity (I2 = 68.4) was considered to be due to one study with more subjects reporting relatively lower success rate. Publication bias is likely due to the lack of negative study publication (Begg’s test P = 0.37, Egger’s test P = 0.0087). Estimated incidences of adverse events were bleeding 3% (95% CI, 2% - 7%), symptomatic pneumoperitoneum 6% (95% CI, 2% - 14%) and POEM related GERD 22% (95% CI, 17% -28%).
Conclusions
POEM after failed endoscopic or surgical therapy is technically feasible and safe as salvage therapy for Achalasia. Further research on long-term sustained clinical success and technical advancement to minimize POEM related GERD are warranted.
Details
- Title: Subtitle
- Sa1277 POEM AS SALVAGE THERAPY FOR ACHALASIA AFTER FAILED ENDOSCOPIC OR SURGICAL THERAPY IS TECHNICALLY FEASIBLE AND SAFE - A SYSTEMATIC REVIEW AND META-ANALYSIS
- Creators
- Rintaro Hashimoto - University of California, Irvine Medical CenterAtsushi Sakuraba - University of ChicagoYutaka Tomizawa - University of Washington
- Resource Type
- Abstract
- Publication Details
- Gastrointestinal endoscopy, Vol.89(6 Supplement), pp.AB201-AB201
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.gie.2019.03.167
- ISSN
- 0016-5107
- eISSN
- 1097-6779
- Language
- English
- Date published
- 06/2019
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984696769402771
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