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Surgical Endoscopy
Published in: Surgical Endoscopy 1/2021

01-01-2021 | Gastroesophageal Reflux Disease

Risk factors for gastroesophageal reflux after POEM for achalasia: a systematic review and meta-analysis

Authors: Raquel Cristina Lins Mota, Eduardo Guimarães Hourneaux de Moura, Diogo Turiani Hourneaux de Moura, Wanderlei Marques Bernardo, Eduardo Turiani Hourneaux de Moura, Vitor O. Brunaldi, Paulo Sakai, Christopher C. Thompson

Published in: Surgical Endoscopy | Issue 1/2021

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Abstract

Introduction

Peroral endoscopic myotomy (POEM) demonstrated similar efficacy to surgical myotomy in the management of achalasia. However, gastroesophageal reflux disease (GERD) is common after POEM. The aim of this study is to identify factors associated with GERD after POEM.

Method

After searching electronic databases, randomized trials and observational studies including patients with achalasia or other spastic esophageal disorders, treated by POEM, and providing GERD data were selected. GERD was evaluated by 3 methods: pH monitoring, endoscopic findings, and symptoms. For each method, an analysis was performed comparing the outcomes related to the following independent variables: full-thickness (FT) vs circular myotomy, anterior vs posterior, long myotomy vs short myotomy, naive vs previous treatment failure, previous Heller myotomy (HM) vs non-previous-HM, Type I vs II, Type I vs III, and Type II vs III.

Results

2869 publications were identified, and 25 studies met criteria for inclusion in the qualitative analysis. Of these, 18 were included in the meta-analysis. According to the endoscopic findings, circular and anterior myotomy demonstrated a lower trend of GERD with borderline significance (p = 0.06; p = 0.07, respectively). In the pH monitoring and symptom analyses, circular myotomy, anterior myotomy, treatment naive, and non-HM patients were associated with a lower occurrence of GERD; however, no statistically significant difference was found. When comparing achalasia subtypes, no statistical difference was found in all analyses.

Conclusion

This systematic review and meta-analysis suggest that a circular anterior approach may limit post-POEM GERD and should be considered in appropriate patients.
Appendix
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Metadata
Title
Risk factors for gastroesophageal reflux after POEM for achalasia: a systematic review and meta-analysis
Authors
Raquel Cristina Lins Mota
Eduardo Guimarães Hourneaux de Moura
Diogo Turiani Hourneaux de Moura
Wanderlei Marques Bernardo
Eduardo Turiani Hourneaux de Moura
Vitor O. Brunaldi
Paulo Sakai
Christopher C. Thompson
Publication date
01-01-2021
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 1/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07412-y

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