Mid-and-Long Term Efficacy Of Peroral Endoscopic Myotomy For Achalasia:Meta Analysis And Systematic Review

[Objective]To evaluate the Mid-and-Long Term safety and efficacy of Peroral Endoscopic Myotomy for the treatment of achalasia,in order to provide reference for clinical practice and research.[Methods]The systematic review searched Pubmed,Ovid,Embase,Medline,the Cochrane Library,CNKI and CBM databases from inception to October 2016.Clinical studies about the safety and effectiveness of the peroral endoscopic myotomy for achalasia were collected.Two researchers screened literature and extracted data strictly and independently according to inclusion and exclusion criteria.The quality of the included studies was evaluated by MINORS scale.meta analysis was carried out by R software.[Results]1.21 articles of 1956 patients were included,all of them are observational studies,including 12 retrospective studies and 9 prospective studies,without RCT.2.The safety of POEM2.1 Perioperative adverse events:17 studies of 1795 patients records of perioperative adverse events,description of the statistical results showed that the main complications during POEM is small mucosal perforation in 127 cases(7.1%),the major adverse events after POEM related to gas in 338 cases(18.8%),the most serious complications is esophageal leak(only1 cases),no deaths.2.2 Incidence of GERD after POEM:The mean follow-up time of 24 months after POEM.meta statistical showes that the rate of GER symptoms was 14%(95%CI:11%-18%),24 hour esophageal PH monitoring of the incidence of pathological reflux was 45%(95%CI:38%-53%),and GERD was relieved after the appropriate PPI.3.Mid-and-long term efficacy of POEM3.1 Surgery success rate of POEM was 98%(95%CI:97%-99%),The mean follow-up time was 24(7.21-39.2)months.the overall remission rate after POEM in follow-up period was 93%(95%CI,:91%-95%).1 years,2 years and 3 years of surgical remission rate were 93%(95%CI:91%-95%),93%(95%CI:87%-97%)and 88%(95%CI:82%-93%).3.2 During the follow-up period,the postoperative scores of Eckardt and LESP were decreased significantly compared with preoperative,POEM symptom score decreased 6.16(95%CI:5.69-6.62),the LESP was measured by HRM decreased 22.37(95%CI:19.46-25.28)mmHg.[Conclusion]The current evidence suggests that:(1)The safety of surgery:most of the complications related to POEM were minor and there was no death case,and the incidence of GERD was low in the mean follow-up period of 2 years,which could be alleviated by proper PPI treatment.(2)The efficacy of surgery:the efficacy of POEM was stable and excellent after a follow-up period of at least 3 years.Therefore,POEM is safe,effective and minimally invasive,POEM is expected to replace LHM to be the "gold standard" for AC.