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KMID : 1040120170030010048
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Evidence and Values in Healthcare
2017 Volume.3 No. 1 p.48 ~ p.56
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Peroral endoscopy myotomy: A systematic review
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Lee Kyung-Min
Jo Sun-Young
Choi Won-Jung
Kim Seok-Hyun
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Abstract
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Objectives: The aim of this research was to assess the safety and effectiveness of Peroral Endoscopic Myotomy (POEM) in Achalasia or Spastic Esophageal Motility Disorder.
Methods: The literature review for Peroral Endoscopic Myotomy (POEM) was done using 8 national databases including KoreaMed and several international databases including Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library. The subcommittee and two additional reviewers independently performed each step of the assessment including literature search, application of the inclusion criteria, evaluation of the article quality, and data extraction. The quality of the articles were evaluated using SIGN (Scottish Intercollegiate Guidelines Network), and the level of evidence and the grade of recommendation were carefully determined and documented based on the quality.
Results: Out of 399 articles (excluding 156 duplicated articles) selected, 49 papers were included in final assessment. The assessment of safety for POEM was based on death and procedure-related complications. the safety of the technique is acceptable as the complications arose in the similar pattern to the existing technique, with the major complication of pulmonary embolism being less than 0.1% (3/3,343) (2 were treated by anticoagulant therapy), and most mild complications, including complications due to air, were cured via additional treatment. The assessment of effectiveness for POEM was based on improved symptoms (Eckardt score change), success rate (Eckardt score below 3), improved function (esophageal manometry), and quality of life. All articles compared the technique against Laparoscopic Heller Myotomy (LHM). The Eckardt score (3 articles) showed similar pattern of symptomatic improvement in both the intervention and the control groups, with one article reporting no significant difference at the time of followup monitoring. The Eckardt score (30 articles) showed post-surgical symptomatic improvement in all articles, and the success rate (15
articles) was 77.5~100%.
Conclusion: Peroral Endoscopic Myotomy (POEM) is a safe and effective technique for improving the symptoms of delayed esophageal discharge and its treatment in patients suffering Achalasia and Esophageal Motility Disorder accompanied by severe chest pain caused by delayed esophageal discharge.
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KEYWORD
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Esophageal motility disorder, Achalasia, Peroral endoscopic myotomy (POEM), Safety, Effectiveness
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