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

机译：贲门划分后胃食管反流的危险因素：系统审查与荟萃分析

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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.
机译：经口内镜下肌切开术（POEM）在贲门失弛缓症的治疗中显示出与外科肌切开术相似的疗效。然而，胃食管反流病（GERD）在POME后很常见。本研究的目的是确定诗歌后GERD的相关因素。方法在搜索电子数据库后，选择随机试验和观察性研究，包括贲门失弛缓症或其他痉挛性食管疾病患者，采用POEM治疗，并提供GERD数据。GERD通过3种方法进行评估：pH监测、内镜检查和症状。对每种方法进行分析，比较与以下自变量相关的结果：全厚度（FT）与环形肌切开术、前肌切开术与后肌切开术、长肌切开术与短肌切开术、单纯性与既往治疗失败、既往Heller肌切开术（HM）与既往HM、I型与II型、I型与III型和II型与III型，25项研究符合纳入定性分析的标准。其中18例纳入荟萃分析。根据内镜检查结果，环形肌切开术和前肌切开术显示GERD的趋势较低，具有临界意义（分别为p=0.06；p=0.07）。在pH监测和症状分析中，环形肌切开术、前肌切开术、未接受治疗的患者和非HM患者与GERD发生率较低相关；然而，没有发现统计上的显著差异。在比较贲门失弛缓症亚型时，所有分析均未发现统计学差异。结论本系统回顾和荟萃分析表明，环形前路手术可能会限制术后GERD，应在适当的患者中予以考虑。

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