Harishankar Gopakumar, Eugene Annor, Ishaan Vohra, Iman Andalib, Amy Tyberg, Avik Sarkar, Haroon Shahid, Mine Carames, Juan Carlos Carames, Giovanna Porfilio Gularte, Abed Al-Lehibi, Resheed Alkhiari, Amol Bapaye, Carlos Robles-Medranda, Michel Kahaleh
{"title":"经口内窥镜下肌切开术治疗贲门失弛缓症（POEM-F）：系统回顾和荟萃分析。","authors":"Harishankar Gopakumar, Eugene Annor, Ishaan Vohra, Iman Andalib, Amy Tyberg, Avik Sarkar, Haroon Shahid, Mine Carames, Juan Carlos Carames, Giovanna Porfilio Gularte, Abed Al-Lehibi, Resheed Alkhiari, Amol Bapaye, Carlos Robles-Medranda, Michel Kahaleh","doi":"10.1055/a-2536-8132","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and study aims: </strong>Gastroesophageal reflux (GER) and its long-term sequelae remain a concern following peroral endoscopic myotomy (POEM). POEM with fundoplication (POEM-F) is simultaneous fundoplication via pure natural orifice transluminal endoscopic surgery (NOTES). In this study, we evaluated the efficacy and safety of POEM-F in mitigating post-POEM GER.</p><p><strong>Methods: </strong>We performed a comprehensive electronic database search from January 2008 through June 2024 for studies evaluating outcomes of POEM-F performed for managing post-POEM GER. Pooled proportions were calculated using random-effects models. Heterogeneity was assessed using I <sup>2</sup> and Q statistics.</p><p><strong>Results: </strong>We included seven studies comprising 127 patients. Pooled technical success for POEM was 96.90%; 95% confidence interval [CI] 91.40-98.90. Pooled technical success of fundoplication was 92.30%; 95% CI 85.20-96.10. Clinical success in treating achalasia was 96.40%; 95% CI 90.70-98.60. Rate of wrap integrity on follow-up was 84.00%; 95% CI 66.00-93.40. Composite clinical success of POEM-F in mitigating post-POEM GER was 86.20%; 95% CI 73.80-93.20. Mean total procedure duration and fundoplication time was 115.74 minutes; 95% CI 103.53-126.96 and 55.28 minutes; 95% CI 47.35-63.20, respectively. The overall pooled major adverse events (AE) rate was 3.60%; 95% CI 1.40-9.40.</p><p><strong>Conclusions: </strong>POEM-F is an effective procedure with an acceptable AE rate in expert hands. It appears to offer clinical benefit in mitigating post-POEM GER. However, further standardization for evaluating clinically significant post-POEM GER and long-term benefit of POEM-F is warranted.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"13 ","pages":"a25368132"},"PeriodicalIF":2.2000,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922173/pdf/","citationCount":"0","resultStr":"{\"title\":\"Peroral endoscopic myotomy with fundoplication (POEM-F) for achalasia: Systematic review and meta-analysis.\",\"authors\":\"Harishankar Gopakumar, Eugene Annor, Ishaan Vohra, Iman Andalib, Amy Tyberg, Avik Sarkar, Haroon Shahid, Mine Carames, Juan Carlos Carames, Giovanna Porfilio Gularte, Abed Al-Lehibi, Resheed Alkhiari, Amol Bapaye, Carlos Robles-Medranda, Michel Kahaleh\",\"doi\":\"10.1055/a-2536-8132\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and study aims: </strong>Gastroesophageal reflux (GER) and its long-term sequelae remain a concern following peroral endoscopic myotomy (POEM). POEM with fundoplication (POEM-F) is simultaneous fundoplication via pure natural orifice transluminal endoscopic surgery (NOTES). In this study, we evaluated the efficacy and safety of POEM-F in mitigating post-POEM GER.</p><p><strong>Methods: </strong>We performed a comprehensive electronic database search from January 2008 through June 2024 for studies evaluating outcomes of POEM-F performed for managing post-POEM GER. Pooled proportions were calculated using random-effects models. Heterogeneity was assessed using I <sup>2</sup> and Q statistics.</p><p><strong>Results: </strong>We included seven studies comprising 127 patients. Pooled technical success for POEM was 96.90%; 95% confidence interval [CI] 91.40-98.90. Pooled technical success of fundoplication was 92.30%; 95% CI 85.20-96.10. Clinical success in treating achalasia was 96.40%; 95% CI 90.70-98.60. Rate of wrap integrity on follow-up was 84.00%; 95% CI 66.00-93.40. Composite clinical success of POEM-F in mitigating post-POEM GER was 86.20%; 95% CI 73.80-93.20. Mean total procedure duration and fundoplication time was 115.74 minutes; 95% CI 103.53-126.96 and 55.28 minutes; 95% CI 47.35-63.20, respectively. The overall pooled major adverse events (AE) rate was 3.60%; 95% CI 1.40-9.40.</p><p><strong>Conclusions: </strong>POEM-F is an effective procedure with an acceptable AE rate in expert hands. It appears to offer clinical benefit in mitigating post-POEM GER. However, further standardization for evaluating clinically significant post-POEM GER and long-term benefit of POEM-F is warranted.</p>\",\"PeriodicalId\":11671,\"journal\":{\"name\":\"Endoscopy International Open\",\"volume\":\"13 \",\"pages\":\"a25368132\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-03-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922173/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Endoscopy International Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2536-8132\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endoscopy International Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1055/a-2536-8132","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景和研究目的：胃食管反流（GER）及其长期后遗症仍然是经口内窥镜肌切开术（POEM）后关注的问题。POEM合并眼底复制（POEM- f）是通过纯天然孔道腔内内镜手术同时进行眼底复制（NOTES）。在这项研究中，我们评估了POEM-F缓解poem后GER的疗效和安全性。方法：我们从2008年1月到2024年6月进行了全面的电子数据库检索，以评估POEM-F治疗poem后GER的结果。采用随机效应模型计算合并比例。异质性评估采用I 2和Q统计。结果：我们纳入了7项研究，共127例患者。POEM的综合技术成功率为96.90%；95%置信区间[CI] 91.40-98.90。综合技术成功率为92.30%；95% ci 85.20-96.10。临床治疗贲门失弛缓症的成功率为96.40%；95% ci为90.70-98.60。随访时包膜完整性为84.00%；95% ci 66.00-93.40。POEM-F缓解poem后GER的综合临床成功率为86.20%；95% ci 73.80-93.20。平均总手术时间和取底时间为115.74分钟；95% CI 103.53 ~ 126.96, 55.28分钟；95% CI分别为47.35-63.20。总主要不良事件（AE）发生率为3.60%；95% ci 1.40-9.40。结论：POEM-F是一种有效的手术方法，AE率在专家手中是可以接受的。它似乎在减轻poem后GER方面提供了临床益处。然而，评估POEM-F术后临床显著性GER和长期获益的进一步标准化是有必要的。
Peroral endoscopic myotomy with fundoplication (POEM-F) for achalasia: Systematic review and meta-analysis.
Background and study aims: Gastroesophageal reflux (GER) and its long-term sequelae remain a concern following peroral endoscopic myotomy (POEM). POEM with fundoplication (POEM-F) is simultaneous fundoplication via pure natural orifice transluminal endoscopic surgery (NOTES). In this study, we evaluated the efficacy and safety of POEM-F in mitigating post-POEM GER.
Methods: We performed a comprehensive electronic database search from January 2008 through June 2024 for studies evaluating outcomes of POEM-F performed for managing post-POEM GER. Pooled proportions were calculated using random-effects models. Heterogeneity was assessed using I 2 and Q statistics.
Results: We included seven studies comprising 127 patients. Pooled technical success for POEM was 96.90%; 95% confidence interval [CI] 91.40-98.90. Pooled technical success of fundoplication was 92.30%; 95% CI 85.20-96.10. Clinical success in treating achalasia was 96.40%; 95% CI 90.70-98.60. Rate of wrap integrity on follow-up was 84.00%; 95% CI 66.00-93.40. Composite clinical success of POEM-F in mitigating post-POEM GER was 86.20%; 95% CI 73.80-93.20. Mean total procedure duration and fundoplication time was 115.74 minutes; 95% CI 103.53-126.96 and 55.28 minutes; 95% CI 47.35-63.20, respectively. The overall pooled major adverse events (AE) rate was 3.60%; 95% CI 1.40-9.40.
Conclusions: POEM-F is an effective procedure with an acceptable AE rate in expert hands. It appears to offer clinical benefit in mitigating post-POEM GER. However, further standardization for evaluating clinically significant post-POEM GER and long-term benefit of POEM-F is warranted.
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