University of South Florida Morsani College of Medicine and University of Central Florida, HCA Healthcare GME Ocala, FL
Abdul-Rahman F. Diab, MD1, Joseph A. Sujka, MD2, Mehak Sachdeva, MD3, Kenneth Hackbarth, DO3, Alexander Thompson, MD3, Salvatore Docimo, DO2, Christopher G. DuCoin, MD2 1University of South Florida Morsani College of Medicine and University of Central Florida, HCA Healthcare GME, Ocala, FL; 2University of South Florida Morsani College of Medicine, Tampa, FL; 3University of Central Florida, HCA Healthcare GME, Ocala, FL
Introduction: Several studies have hypothesized that sparing the sling/oblique fibers during peroral endoscopic myotomy (POEM) for achalasia may reduce the incidence of gastroesophageal reflux disease (GERD) and reflux esophagitis without compromising the well-established safety and efficacy of POEM in treating achalasia. This study compares perioperative outcomes, postoperative achalasia-related outcomes, and postoperative GERD-related outcomes between sling fibers preserving POEM (SFP-POEM) and conventional POEM by performing a pairwise meta-analysis of comparative studies.
Methods: We conducted a systematic literature review following PRISMA guidelines to identify articles directly comparing endoscopic SFP-POEM with conventional POEM for achalasia. We utilized the random effects model and calculated odds ratios for dichotomous data, as well as mean differences for continuous data, as metrics for effect size.
Results: No significant differences were observed in perioperative outcomes, including mean gastric myotomy length, mean operative time, and incidence of adverse events. Similarly, no significant differences were noted in postoperative achalasia-related outcomes, including mean Eckhardt score and mean integrated relaxation pressure. Regarding postoperative GERD-related outcomes, a statistically significant decrease in the incidence of symptomatic GERD was observed in favor of SFP-POEM. The number needed to treat (NNT) with SFP-POEM to prevent one case of symptomatic GERD was 10 (95% CI 6–49). Interestingly, no significant differences were found in postoperative GERD-related objective outcomes, such as the number of patients with DeMeester scores > 14 and the incidence of reflux esophagitis.
Discussion: This study suggests that SFP-POEM might reduce the incidence of symptomatic GERD (a subjective outcome) without affecting GERD-related objective outcomes, such as the number of patients with DeMeester scores > 14 and the incidence of reflux esophagitis. However, due to the lack of randomized controlled trials (RCTs) on this topic, these findings remain inconclusive. Further research, particularly RCTs, is necessary to reach solid conclusions.
Figure: Symptomatic GERD (Figure A), reflux esophagitis (LA Grades ≥ B) (Figure B), and reflux esophagitis (LA Grades ≥ C) (Figure C).
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Abdul-Rahman Diab indicated no relevant financial relationships.
Joseph Sujka indicated no relevant financial relationships.
Mehak Sachdeva indicated no relevant financial relationships.
Kenneth Hackbarth indicated no relevant financial relationships.
Alexander Thompson indicated no relevant financial relationships.
Salvatore Docimo indicated no relevant financial relationships.
Christopher DuCoin indicated no relevant financial relationships.
Abdul-Rahman F. Diab, MD1, Joseph A. Sujka, MD2, Mehak Sachdeva, MD3, Kenneth Hackbarth, DO3, Alexander Thompson, MD3, Salvatore Docimo, DO2, Christopher G. DuCoin, MD2. P1027 - Peroral Endoscopic Myotomy for Achalasia With Versus Without Sling/Oblique Fibers Preservation, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
