ABSTRACT
Peroral endoscopic myotomy (POEM) has emerged as a rescue treatment for recurrent or persistent achalasia after failed initial management. Therefore, we aimed to investigate the efficacy and safety of POEM in achalasia patients with failed previous intervention. We searched the MEDLINE, Embase, Cochrane, and PubMed databases using the queries “achalasia,” “peroral endoscopic myotomy,” and related terms in March 2019. Data on technical and clinical success, adverse events, Eckardt score and lower esophageal sphincter (LES) pressure were collected.The pooled event rates, mean differences (MDs) and risk ratios (RR) were calculated. A total of 15 studies with 2,276 achalasia patients were included. Overall, the pooled technical success, clinical success and adverse events rate of rescue POEM were 98.0% (95% confidence interval [CI], 96.6% to 98.8%), 90.8% (95% CI, 88.8% to 92.4%) and 10.3% (95% CI, 6.6% to 15.8%), respectively. Seven studies compared the clinical outcomes of POEM between previous failed treatment and the treatment naïve patients. The RR for technical success, clinical success, and adverse events were 1.00 (95% CI, 0.98 to 1.01), 0.98 (95% CI, 0.92 to 1.04), and 1.17 (95% CI, 0.78 to 1.76), respectively. Overall, there was significant reduction in the pre- and post-Eckardt score (MD, 5.77; p<0.001) and LES pressure (MD, 18.3 mm Hg; p<0.001) for achalasia patients with failed previous intervention after POEM. POEM appears to be a safe, effective and feasible treatment for individuals who have undergone previous failed intervention. It has similar outcomes in previously treated and treatment-naïve achalasia patients.
ABSTRACT
Objective To evaluate the clinical manifestations, endoscopic features and the clinical pathological characteristics of H. heilmannii-associated gastritis, and to compare these variables with those of H. pylori-ussociated gastritis. Methods The clinical data, endoscopic findings and pathologic characteristics of 3107 patients, who underwent endoscopy from 2005 to 2007, were retrospectively analyzed. Results Twenty-five cases of H. heilmannii infection were identified, the infection rates of H. heilmannii and H. pylori were 0.80% (25/3107) and 4.12% (1060/3107) respectively. Three cases were mixed infections. Of 25 patients, 20 showed such gastroenterologic symptoms to a greater or less extent as abdominal distending pain,nausea and anorexia, and other 5 cases were asymptomatic. All 25 patients showed chronic gastritis by en-doscopy, including chronic superficial gastritis (7/25, 28% ), erosion ( 3/25, 12% ), chronic atrophic gastritis (4/25, 16%), bile reflux(1/25, 4%), ulcer (1/25, 4%), polyp (1/25, 4%) and duodenal bulbar inflammation (2/25, 8% ). In rapid urease test, 3 cases were hyper-positive, 3 cases positive, 7 ca-ses mild-positive and 12 cases negative. According to histological observation, H. heilmannii scattered or ac-cumulated within the gastric pits, glandular lumen or mucus. The organism was observed in parietal cells with cell damage in one case. Sporadic lymphatic and plasmic infiltration were found in all patients with H.heilmannii infection, infiltration of neutrophils (12/25), gland atrophy and intestinal metaplasia (4/25)and lymphoid follicles (6/25) were also observed. Compared with H. pylori-associated gastritis, H. heilman-nii-associated gastritis showed less inflammation, less helicobacter density, mononuclear cell infiltration and neutrophilic activity ( P < 0.05 ). Conclusion H. heilmanaii mainly induces chronic gastritis, which is less severe than H. pylori-associated gastritis.
