Pu XX, Huang S, Zhong CY, Wang X, Fu SF, Lv YQ, Zou K, Lü MH, Peng Y, Tang XW. Safety and efficacy of peroral endoscopic myotomy for treating achalasia in pediatric and geriatric patients: A meta-analysis. World J Gastrointest Endosc 2024; 16(10): 566-580 [DOI: 10.4253/wjge.v16.i10.566]
Corresponding Author of This Article
Xiao-Wei Tang, MD, PhD, Associate Professor, Postdoc, Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang Region, Luzhou 646000, Sichuan Province, China. solitude5834@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Oct 16, 2024; 16(10): 566-580 Published online Oct 16, 2024. doi: 10.4253/wjge.v16.i10.566
Safety and efficacy of peroral endoscopic myotomy for treating achalasia in pediatric and geriatric patients: A meta-analysis
Xin-Xin Pu, Shu Huang, Chun-Yu Zhong, Xia Wang, Su-Fen Fu, Ying-Qin Lv, Kang Zou, Mu-Han Lü, Yan Peng, Xiao-Wei Tang
Xin-Xin Pu, Xia Wang, Su-Fen Fu, Department of Gastroenterology, Dechang People’s Hospital of Sichuan Province, Liangshan 615500, Sichuan Province, China
Xin-Xin Pu, Ying-Qin Lv, Kang Zou, Mu-Han Lü, Yan Peng, Xiao-Wei Tang, Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Shu Huang, Department of Gastroenterology, Lianshui People’s Hospital of Kangda College Affiliated to Nanjing Medical University, Huaian 223499, Jiangsu Province, China
Chun-Yu Zhong, Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Co-first authors: Xin-Xin Pu and Shu Huang.
Author contributions: Tang XW and Pu XX contributed to study conception and design; Pu XX, Huang S and Zhong CY contributed to drafting of the manuscript; Wang X, Fu SF, Lv YQ, Zou K, Lü MH contributed to acquisition of data and critical revision; Tang XW and Peng Y contributed to revision of the manuscript, and final approval of the manuscript; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Wei Tang, MD, PhD, Associate Professor, Postdoc, Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang Region, Luzhou 646000, Sichuan Province, China. solitude5834@hotmail.com
Received: May 24, 2024 Revised: August 17, 2024 Accepted: September 14, 2024 Published online: October 16, 2024 Processing time: 144 Days and 2.7 Hours
Abstract
BACKGROUND
As a less invasive technique, peroral endoscopic myotomy (POEM) has recently been widely accepted for treating achalasia with an excellent safety profile, durability, and efficacy in adults. In pediatric and geriatric patients, the treatment is more difficult.
AIM
To discuss the clinical outcomes of POEM in pediatric and geriatric patients with achalasia.
METHODS
We conducted a comprehensive search of PubMed, Embase and Cochrane Library databases from inception to July 2024. The primary outcomes were technical and clinical success. Secondary outcomes of interest included adverse events and gastroesophageal reflux disease (GERD). The pooled event rates were calculated by comprehensive meta-analysis software.
RESULTS
A total of 32 studies with 547 pediatric patients and 810 geriatric patients were included in this study. The pooled event rates of technical success, clinical success, GERD and adverse events of POEM for treating achalasia in pediatric patients were 97.1% [95% confidence interval (CI): 95.0%-98.3%; I² = 0%; P < 0.000], 93.2% (95%CI: 90.5%-95.2%; I² = 0%; P < 0.000), 22.3% (95%CI: 18.4%-26.7%; I² = 43.874%; P < 0.000) and 20.4% (95%CI: 16.6%-24.8%; I² = 67.217%; P < 0.000), respectively. Furthermore, in geriatric patients, the pooled event rates were 97.7% (95%CI: 95.8%-98.7%; I² = 15.200%; P < 0.000), 93.2% (95%CI: 90.3%-95.2%; I² = 0%; P < 0.000), 23.9% (95%CI: 19.4%-29.1%; I² = 75.697%; P < 0.000) and 10.8% (95%CI: 8.3%-14.0%; I² = 62.938%; P < 0.000], respectively.
CONCLUSION
Our findings demonstrated that POEM was an effective and safe technique for pediatric and geriatric patients with achalasia.
Core Tip: Peroral endoscopic myotomy (POEM), a minimally invasive procedure, has gained substantial acceptance as a treatment for achalasia due to its excellent safety profile, durability, and efficacy in adults. We conducted this systematic review and meta-analysis to summarize the durability, safety, and efficacy of POEM for treating achalasia in pediatric and geriatric patients. Our results indicated that POEM was an effective and safe technique for pediatric and geriatric patients with achalasia.
