{"title":"单次经口内窥镜肌切开术治疗贲门失弛缓症安全有效吗？系统回顾和荟萃分析。","authors":"Yusuf Kagzi, Abuzar Asif, Srinivas Reddy Puli","doi":"10.1002/deo2.70220","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Peroral endoscopic myotomy (POEM) is a minimally invasive treatment for achalasia but is often associated with gastroesophageal reflux disease (GERD). Adding fundoplication (POEM+F) may reduce reflux while maintaining the benefits of myotomy. This systematic review and meta-analysis evaluate the efficacy and safety of POEM+F in achalasia patients.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A comprehensive search of electronic databases and conference proceedings was conducted through November 2024 to identify studies on POEM+F. Pooled proportions were calculated using both fixed effects models. Heterogeneity was assessed via Cochran's Q test. Primary outcomes included technical success, Eckardt score improvement, and post-procedure esophagitis. Secondary outcomes included procedure time, adverse events, wrap integrity, and hospital stay.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Nine studies with 202 patients were included. The pooled technical success rate was 94.80% (95% confidence interval [CI]: 91.37–97.40). Mean total procedure time was 110.51 min, with 52.04 min for fundoplication. Eckardt scores improved from 8.30 (95% CI: 6.83–9.76) pre-operatively to 1.08 (95% CI: 0.33–2.50) post-operatively. Post-procedure, 11.52% (95% CI: 6.10–18.38) had abnormal acid exposure and 20.65% (95% CI: 14.47–27.61) developed esophagitis. An intact wrap was seen in 75.69% (95% CI: 58.55–89.40) on follow-up endoscopy. Mean hospital stay was 2.27 days (95% CI: 1.09–3.45).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>POEM with fundoplication is a safe and effective treatment for achalasia, offering high technical success, symptom relief, and a low incidence of GERD.</p>\n </section>\n </div>","PeriodicalId":93973,"journal":{"name":"DEN open","volume":"6 1","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506599/pdf/","citationCount":"0","resultStr":"{\"title\":\"Is Single-Session Peroral Endoscopic Myotomy With Fundoplication Safe and Effective in Achalasia? A Systematic Review and Meta-Analysis\",\"authors\":\"Yusuf Kagzi, Abuzar Asif, Srinivas Reddy Puli\",\"doi\":\"10.1002/deo2.70220\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Peroral endoscopic myotomy (POEM) is a minimally invasive treatment for achalasia but is often associated with gastroesophageal reflux disease (GERD). Adding fundoplication (POEM+F) may reduce reflux while maintaining the benefits of myotomy. This systematic review and meta-analysis evaluate the efficacy and safety of POEM+F in achalasia patients.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A comprehensive search of electronic databases and conference proceedings was conducted through November 2024 to identify studies on POEM+F. Pooled proportions were calculated using both fixed effects models. Heterogeneity was assessed via Cochran's Q test. Primary outcomes included technical success, Eckardt score improvement, and post-procedure esophagitis. Secondary outcomes included procedure time, adverse events, wrap integrity, and hospital stay.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Nine studies with 202 patients were included. The pooled technical success rate was 94.80% (95% confidence interval [CI]: 91.37–97.40). Mean total procedure time was 110.51 min, with 52.04 min for fundoplication. Eckardt scores improved from 8.30 (95% CI: 6.83–9.76) pre-operatively to 1.08 (95% CI: 0.33–2.50) post-operatively. Post-procedure, 11.52% (95% CI: 6.10–18.38) had abnormal acid exposure and 20.65% (95% CI: 14.47–27.61) developed esophagitis. An intact wrap was seen in 75.69% (95% CI: 58.55–89.40) on follow-up endoscopy. Mean hospital stay was 2.27 days (95% CI: 1.09–3.45).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>POEM with fundoplication is a safe and effective treatment for achalasia, offering high technical success, symptom relief, and a low incidence of GERD.</p>\\n </section>\\n </div>\",\"PeriodicalId\":93973,\"journal\":{\"name\":\"DEN open\",\"volume\":\"6 1\",\"pages\":\"\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2025-10-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506599/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"DEN open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/deo2.70220\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"DEN open","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/deo2.70220","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Is Single-Session Peroral Endoscopic Myotomy With Fundoplication Safe and Effective in Achalasia? A Systematic Review and Meta-Analysis
Background
Peroral endoscopic myotomy (POEM) is a minimally invasive treatment for achalasia but is often associated with gastroesophageal reflux disease (GERD). Adding fundoplication (POEM+F) may reduce reflux while maintaining the benefits of myotomy. This systematic review and meta-analysis evaluate the efficacy and safety of POEM+F in achalasia patients.
Methods
A comprehensive search of electronic databases and conference proceedings was conducted through November 2024 to identify studies on POEM+F. Pooled proportions were calculated using both fixed effects models. Heterogeneity was assessed via Cochran's Q test. Primary outcomes included technical success, Eckardt score improvement, and post-procedure esophagitis. Secondary outcomes included procedure time, adverse events, wrap integrity, and hospital stay.
Results
Nine studies with 202 patients were included. The pooled technical success rate was 94.80% (95% confidence interval [CI]: 91.37–97.40). Mean total procedure time was 110.51 min, with 52.04 min for fundoplication. Eckardt scores improved from 8.30 (95% CI: 6.83–9.76) pre-operatively to 1.08 (95% CI: 0.33–2.50) post-operatively. Post-procedure, 11.52% (95% CI: 6.10–18.38) had abnormal acid exposure and 20.65% (95% CI: 14.47–27.61) developed esophagitis. An intact wrap was seen in 75.69% (95% CI: 58.55–89.40) on follow-up endoscopy. Mean hospital stay was 2.27 days (95% CI: 1.09–3.45).
Conclusions
POEM with fundoplication is a safe and effective treatment for achalasia, offering high technical success, symptom relief, and a low incidence of GERD.
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