Peroral Endoscopic Myotomy Is a Safe and Feasible Option in Management of Esophageal Diverticula: Systematic Review and
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REVIEW
Peroral Endoscopic Myotomy Is a Safe and Feasible Option in Management of Esophageal Diverticula: Systematic Review and Meta‑Analysis Faisal Kamal1 · Muhammad Ali Khan2 · Wade Lee‑Smith3 · Sachit Sharma4 · Hemnishil K. Marella1 · Umair Iqbal5 · Stephanie Mcdonough6 · Aysha Aslam7 · Mohammad K. Ismail1 · Claudio Tombazzi1 · Douglas G. Adler6 Received: 26 August 2020 / Accepted: 13 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Esophageal diverticula can cause significant symptoms and affect the quality of life. There has been recent interest in the use of peroral endoscopic myotomy in the management of esophageal diverticula (D-POEM). In this meta-analysis, we have evaluated the efficacy and safety of D-POEM in the management of esophageal diverticula. Several databases were reviewed from inception to 6/19/2020 to identify the studies evaluating the feasibility, efficacy and safety of D-POEM in the management of esophageal diverticula. Our outcomes of interest were technical success, adverse events and difference in mean pre- and post-procedure symptom score. We performed subgroup analysis including patients with Zenker’s diverticulum who underwent POEM (Z-POEM). Pooled rates with 95% confidence intervals (CI) for all outcomes were calculated using random effect model. We calculated standard mean difference (SMD) with 95% CI to compare mean pre- and post-procedure symptom score. We included 7 studies with 233 patients. For D-POEM, pooled rates (95% CI) for technical success and adverse events were 95% (91%, 97%) and 6% (3%, 10%) respectively. For Z-POEM, pooled rates (95% CI) for technical success and adverse events were 95% (90%, 97%) and 6% (3%, 10%) respectively. Mean post-procedure symptom score for all patients who underwent D-POEM was significantly lower compared to mean pre-procedure symptom score, SMD (95% CI) 2.17 (1.51, 2.83). This meta-analysis demonstrated that D-POEM is a safe and feasible option for patients with symptomatic esophageal diverticula. Keywords Peroral endoscopic myotomy · Esophageal diverticula · Zenker’s diverticulum · Meta-analysis
Introduction Esophageal diverticula can cause symptoms such as dysphagia, aspiration, regurgitation or chest pain affecting the quality of life [1]. Esophageal diverticula are classified into three Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10620-020-06678-5) contains supplementary material, which is available to authorized users. * Douglas G. Adler [email protected] 1
Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN, USA
2
Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, AL, USA
3
Mulford Health Sciences Library, University of Toledo, Toledo, OH, USA
types based on pathophysiology and location in esophagus: Zenker’s, mid-esophageal, and epiphrenic diverticula [2]. Surgical management of esophageal diverticula is associated with good long-term outcomes, but
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