{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T22:55:33Z","timestamp":1777416933766,"version":"3.51.4"},"reference-count":50,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2020,3,20]],"date-time":"2020-03-20T00:00:00Z","timestamp":1584662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec><jats:title>Backgrounds and aims<\/jats:title><jats:p>Per oral endoscopic myotomy (POEM) has been reported as an effective and safe salvage therapy for achalasia but there is limited composite data. We performed a systematic review and meta\u2010analysis of studies that reported the rates of clinical success and adverse events among patients who underwent POEM after failed conventional endoscopic or surgical therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Electronic literature search was conducted from inception through December 2018 for articles reporting the efficacy and safety of POEM in patients with achalasia who failed endoscopic or surgical therapy. Primary outcome was the pooled estimated rates of clinical success, defined as Eckardt score\u00a0\u2264\u00a03 after POEM. Secondary outcomes were procedural time, the rates of POEM\u2010related gastroesophageal reflux disease (GERD) and procedure\u2010related adverse events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven studies reporting outcomes on 487 patients met our criteria. Pooled estimated rate of clinical success of POEM was 88% (95% confidence interval (CI) 79\u201394%). Mean procedural time was 64\u00a0minutes (95% CI 44\u201385\u00a0minutes). POEM\u2010related GERD was found in 20% (95% CI 16\u201324%) of patients. Estimated incidence of overall adverse events was 10% (95% CI 5\u201318%) with individual risk of bleeding, mucosotomy, pneumothorax, pneumoperitoneum hydrothorax\/mediastinitis, and subcutaneous emphysema ranging from 1 to 4%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Per oral endoscopic myotomy after failed endoscopic or surgical therapy in patients with achalasia is an effective and safe treatment. Further long\u2010term follow\u2010up studies in a larger number of patients are warranted to validate the sustainable efficacy of POEM for achalasia.<\/jats:p><\/jats:sec>","DOI":"10.1111\/den.13643","type":"journal-article","created":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T20:38:25Z","timestamp":1580762305000},"page":"1042-1049","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Per oral endoscopic myotomy as salvage therapy in patients with achalasia refractory to endoscopic or surgical therapy is technically feasible and safe: Systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6947-4138","authenticated-orcid":false,"given":"Rintaro","family":"Hashimoto","sequence":"first","affiliation":[{"name":"Division of Gastroenterology University of California Irvine Medical Center Orange 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