title: Is POEM the Answer for Management of Spastic Esophageal Disorders? A Systematic Review and Meta-Analysis.
abstract: Spastic esophageal disorders (SEDs) include spastic achalasia (type III), diffuse esophageal spasm (DES), and nutcracker/jackhammer esophagus (JH). Per-oral endoscopic myotomy (POEM) has demonstrated efficacy and safety in the treatment of achalasia. Recently, POEM has been indicated for the treatment of SEDs. We conducted a systematic review and meta-analysis to determine the clinical success and safety of POEM in SEDs.
  
  
  
  We searched several databases from 01/01/2007 to 01/10/2016 to identify studies (with five or more patients) on POEM for the treatment of SEDs. Weighted pooled rates (WPRs) for clinical success and adverse events (AEs) were calculated for all SEDs. Clinical success was defined as Eckardt scores of ≤3 and/or improvement in severity of dysphagia based on achalasia disease-specific health-related quality of life questionnaire. The WPRs for clinical success and AEs were analyzed using fixed- or random-effects model based on heterogeneity. The proportionate difference in clinical success and post-procedure adverse event rates among individual types of SEDs was also calculated.
  
  
  
  A total of eight observational studies with 179 patients were included in the final analysis. Two studies were of good quality and six were of fair quality based on the National Institutes of Health quality assessment tool. The WPR with 95% confidence interval (CI) for cumulative clinical success of POEM in all SEDs was 87% (78, 93%), I2= 37%. The total number of patients for individual disorders, i.e., type III achalasia, JH, and DES, was 116, 37, and 18, respectively. The WPRs for clinical success of POEM for type III achalasia, DES, and JH were 92, 88, and 72%, respectively. Proportion difference of WPR for clinical success was significantly higher for type III achalasia in comparison with JH (20%, P = 0.01). The WPR with 95% CI for AEs of POEM in all SEDs was 14% (9, 20%), I2= 0%. The WPRs for post-procedure adverse events for type III achalasia, DES, and JH were 11, 14, and 16%, respectively. There was no difference in safety of POEM among individual SEDs.
  
  
  
  POEM is an effective and safe therapeutic modality for the treatment of spastic esophageal disorders.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Muhammad Ali
authors.initials: MA
authors.lastname: Khan
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans St., Suite 7125 B, Baltimore, MD, 21205, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumbhari
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans St., Suite 7125 B, Baltimore, MD, 21205, USA.
authors.forename: Saowanee
authors.initials: S
authors.lastname: Ngamruengphong
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans St., Suite 7125 B, Baltimore, MD, 21205, USA.
authors.forename: Amr
authors.initials: A
authors.lastname: Ismail
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans St., Suite 7125 B, Baltimore, MD, 21205, USA.
authors.forename: Yen-I
authors.initials: YI
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans St., Suite 7125 B, Baltimore, MD, 21205, USA.
authors.forename: Yamile Haito
authors.initials: YH
authors.lastname: Chavez
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans St., Suite 7125 B, Baltimore, MD, 21205, USA.
authors.forename: Majidah
authors.initials: M
authors.lastname: Bukhari
authors.affiliation: Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Nollan
authors.affiliation: Division of Gastroenterology and Hepatology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Mohammad Kashif
authors.initials: MK
authors.lastname: Ismail
authors.affiliation: Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Onimaru
authors.affiliation: Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
authors.forename: Valerio
authors.initials: V
authors.lastname: Balassone
authors.affiliation: Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sharata
authors.affiliation: Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Swanstrom
authors.affiliation: Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Humanitas University, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.affiliation: Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, 1800 Orleans St., Suite 7125 B, Baltimore, MD, 21205, USA. mkhasha1@jhmi.edu.
authors.forename: Mouen A
authors.initials: MA
authors.lastname: Khashab
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D004931:Esophageal Achalasia / Q000150:complications / Q000601:surgery*; D015154:Esophageal Motility Disorders / Q000150:complications / Q000601:surgery; D015155:Esophageal Spasm, Diffuse / Q000150:complications / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery; D011788:Quality of Life; D016896:Treatment Outcome
keywords: Achalasia; Diffuse esophageal spasm; Jackhammer esophagus; POEM; Spastic achalasia; Spastic esophageal disorders