GERD after per-oral endoscopic myotomy as compared with Heller's myotomy with fundoplication

TY - JOUR

T1 - GERD after per-oral endoscopic myotomy as compared with Heller's myotomy with fundoplication

AU - Repici, Alessandro

AU - Fuccio, Lorenzo

AU - Maselli, Roberta

AU - Mazza, Fabrizio

AU - Correale, Loredana

AU - Mandolesi, Daniele

AU - Bellisario, Cristina

AU - Sethi, Amrita

AU - Kashab, Mouen

AU - Rösch, Thomas

AU - Hassan, Cesare

N1 - Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

PY - 2018/4

Y1 - 2018/4

N2 - BACKGROUND AND AIMS: Per-oral endoscopic myotomy (POEM) represents a less invasive alternative to conventional laparoscopic Heller's myotomy (LHM) for patients with achalasia. It cannot be excluded, however, that the lack of fundoplication after POEM may result in a higher incidence of reflux disease, as compared with LHM. The aim of our study was to conduct a systematic review of prospective studies reporting the incidence of reflux disease developed after POEM and LHM.METHODS: A literature search with electronic databases was performed (up to February 2017) to identify full articles on the incidence of gastroesophageal reflux symptoms and endoscopic monitoring and pH monitoring findings after POEM and LHM (with fundoplication). Proportions and rates were pooled by means of random or fixed-effects models, according to the level of heterogeneity between studies.RESULTS: After we applied the selection criteria, 17 and 28 studies, including 1542 and 2581 participants who underwent POEM and LHM, respectively, were included. The pooled rate of postprocedural symptoms was 19.0% (95% confidence interval [CI], 15.7%-22.8%) after POEM and 8.8% (95% CI, 5.3%-14.1%) after LHM, respectively. The pooled rate estimate of abnormal acid exposure at pH monitoring was 39.0% (95% CI, 24.5%-55.8%) after POEM and 16.8% (95% CI, 10.2%-26.4%) after LHM, respectively. The rate of esophagitis after POEM was 29.4% (95% CI, 18.5%-43.3%) after POEM and 7.6% (95% CI, 4.1%-13.7%) after LHM. At meta-regression, heterogeneity was explained partly by the POEM approach and study population.CONCLUSION: The incidence of reflux disease appears to be significantly more frequent after POEM than after LHM with fundoplication. Monitoring pH and ensuring appropriate treatment after POEM should be considered in order to prevent long-term reflux-related adverse events.

AB - BACKGROUND AND AIMS: Per-oral endoscopic myotomy (POEM) represents a less invasive alternative to conventional laparoscopic Heller's myotomy (LHM) for patients with achalasia. It cannot be excluded, however, that the lack of fundoplication after POEM may result in a higher incidence of reflux disease, as compared with LHM. The aim of our study was to conduct a systematic review of prospective studies reporting the incidence of reflux disease developed after POEM and LHM.METHODS: A literature search with electronic databases was performed (up to February 2017) to identify full articles on the incidence of gastroesophageal reflux symptoms and endoscopic monitoring and pH monitoring findings after POEM and LHM (with fundoplication). Proportions and rates were pooled by means of random or fixed-effects models, according to the level of heterogeneity between studies.RESULTS: After we applied the selection criteria, 17 and 28 studies, including 1542 and 2581 participants who underwent POEM and LHM, respectively, were included. The pooled rate of postprocedural symptoms was 19.0% (95% confidence interval [CI], 15.7%-22.8%) after POEM and 8.8% (95% CI, 5.3%-14.1%) after LHM, respectively. The pooled rate estimate of abnormal acid exposure at pH monitoring was 39.0% (95% CI, 24.5%-55.8%) after POEM and 16.8% (95% CI, 10.2%-26.4%) after LHM, respectively. The rate of esophagitis after POEM was 29.4% (95% CI, 18.5%-43.3%) after POEM and 7.6% (95% CI, 4.1%-13.7%) after LHM. At meta-regression, heterogeneity was explained partly by the POEM approach and study population.CONCLUSION: The incidence of reflux disease appears to be significantly more frequent after POEM than after LHM with fundoplication. Monitoring pH and ensuring appropriate treatment after POEM should be considered in order to prevent long-term reflux-related adverse events.

KW - Journal Article

KW - Review

KW - Esophagitis/epidemiology

KW - Fundoplication/adverse effects

KW - Heller Myotomy/adverse effects

KW - Esophageal pH Monitoring

KW - Humans

KW - Endoscopy, Gastrointestinal

KW - Esophageal Achalasia/surgery

KW - Gastroesophageal Reflux/epidemiology

KW - Myotomy/adverse effects

KW - Incidence

U2 - 10.1016/j.gie.2017.10.022

DO - 10.1016/j.gie.2017.10.022

M3 - SCORING: Review article

C2 - 29102729

VL - 87

SP - 934-943.e18

JO - GASTROINTEST ENDOSC

JF - GASTROINTEST ENDOSC

SN - 0016-5107

IS - 4

ER -