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 stud...
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Georg Thieme Verlag KG
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| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-2536-8132 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Harishankar Gopakumar |
| collection | DOAJ |
| description |
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 I2 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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| format | Article |
| id | doaj-art-af79adf9c67d4dcbbabafae55dae297b |
| institution | Kabale University |
| issn | 2364-3722 2196-9736 |
| language | English |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj-art-af79adf9c67d4dcbbabafae55dae297b2025-02-11T00:06:54ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-973610.1055/a-2536-8132Peroral endoscopic myotomy with fundoplication (POEM-F) for achalasia: Systematic review and meta-analysisHarishankar Gopakumar0https://orcid.org/0000-0002-4921-8794Eugene Annor1Ishaan Vohra2https://orcid.org/0000-0002-9715-8829Iman Andalib3Amy Tyberg4Avik Sarkar5Haroon Shahid6Mine Carames7Juan Carlos Carames8Giovanna Porfilio Gularte9Abed Al-Lehibi10https://orcid.org/0000-0002-4375-0384Resheed Alkhiari11Amol Bapaye12Carlos Robles-Medranda13https://orcid.org/0000-0003-2434-3369Michel Kahaleh14https://orcid.org/0000-0003-0836-6114Gastroenterology and Hepatology, OSF Saint Joseph Medical CenterInternal Medicine, University of Illinois Chicago College of Medicine at Peoria, Peoria, United StatesGastroenterology, UIC peoria, Peoria, United StatesGastroenterology, Hackensack Meridian Hackensack University Medical Center, Hackensack, United StatesGastroenterology & Hepatology, Hackensack Meridian JFK University Medical Center, Edison, United StatesGastroenterology, Hackensack Meridian JFK University Medical Center, Edison, United StatesGastroenterology, Hackensack Meridian JFK University Medical Center, Edison, United StatesGastroenterology, Santander Hospital, Mexico City, MexicoGastroenterology, Santander Hospital, Mexico City, MexicoGastroenterology, Instituto Misionero de Gastroenterología y Motilidad Digestiva, Posadas, ArgentinaGastroenterology & Hepatology, King Fahad Medical City, Riyadh, Saudi ArabiaGastroenterology, King Fahad Medical City, Riyadh, Saudi ArabiaShivanand Desai Center for Digestive Disorders,, Deenanath Mangeshkar Hospital and Research Center, Pune, IndiaGastroenterology, Instituto Ecuatoriano de Enfermedades Digestivas - IECED, Guayaquil, EcuadorGastroenterology, Foundation of Interventional and Therapeutic Endoscopy, New Brunswick, United States 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 I2 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. http://www.thieme-connect.de/DOI/DOI?10.1055/a-2536-8132 |
| spellingShingle | 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 Peroral endoscopic myotomy with fundoplication (POEM-F) for achalasia: Systematic review and meta-analysis Endoscopy International Open |
| title | Peroral endoscopic myotomy with fundoplication (POEM-F) for achalasia: Systematic review and meta-analysis |
| title_full | Peroral endoscopic myotomy with fundoplication (POEM-F) for achalasia: Systematic review and meta-analysis |
| title_fullStr | Peroral endoscopic myotomy with fundoplication (POEM-F) for achalasia: Systematic review and meta-analysis |
| title_full_unstemmed | Peroral endoscopic myotomy with fundoplication (POEM-F) for achalasia: Systematic review and meta-analysis |
| title_short | Peroral endoscopic myotomy with fundoplication (POEM-F) for achalasia: Systematic review and meta-analysis |
| title_sort | peroral endoscopic myotomy with fundoplication poem f for achalasia systematic review and meta analysis |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-2536-8132 |
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