Supplementary Material for: The Effect of Peroral Endoscopic Myotomy in Achalasia Patients with Prior Endoscopic Intervention: A Systematic Review and Meta-Analysis

<b><i>Background:</i></b> Peroral endoscopic myotomy (POEM) has been reported to be effective in achalasia patients with prior failed endoscopic intervention (PFI). We performed this meta-analysis to compare and summarize the clinical outcome of POEM in patients with or without prior endoscopic intervention. <b><i>Method:</i></b> We searched relevant studies published up to March 2020. Meta-analysis for technical success, clinical success, Eckardt score, lower esophageal sphincter (LES) pressure, clinical reflux, and adverse event were conducted based on a random-effects model. <b><i>Results:</i></b> Eight studies enrolling 1,797 patients who underwent POEM were enrolled, including 1,128 naïve achalasia patients and 669 patients with PFI. In the PFI group, the pooled estimated rate of technical success was 97.7% (95% confidence interval [CI], 95.8–98.8%), the pooled clinical success rate was 91.0% (95% CI, 88.0–93.4%), and the pooled adverse events rate was 23.5% (95% CI, 10.6–44.1%). The Eckardt score significantly decreased by 5.95 points (95% CI, 5.50–6.40, <i>p</i> &lt; 0.00001) and the LES pressure significantly reduced by 19.74 mm Hg (95% CI, 14.10–25.39, <i>p</i> &lt; 0.00001) in the PFI group. There were no difference in the technical success, clinical success, and adverse events rate between the treatment-naïve group and PFI group, with a risk ratio of 1.0 (95% CI, 0.99–1.01, <i>p</i> = 0.89), 1.02 (95% CI, 0.98–1.06, <i>p</i> = 0.36), and 0.88 (95% CI, 0.67–1.16, <i>p</i> = 0.38), respectively. <b><i>Conclusions:</i></b> POEM is an effective and safe treatment for achalasia patients with prior endoscopic intervention. Randomized clinical trials are needed to further verify the efficiency and safety of the POEM in those patients.

<b><i>背景：</i></b> 已有研究证实经口内镜下肌切开术（Peroral Endoscopic Myotomy, POEM）对既往内镜治疗失败（Prior Failed Endoscopic Intervention, PFI）的贲门失弛缓症患者具有治疗效果。本研究开展此项荟萃分析，旨在对比并总结经口内镜下肌切开术在既往接受过内镜治疗与未接受过内镜治疗的贲门失弛缓症患者中的临床结局。<b><i>方法：</i></b> 我们检索了截至2020年3月发表的相关研究。基于随机效应模型，针对技术成功率、临床成功率、Eckardt评分、食管下括约肌（Lower Esophageal Sphincter, LES）压力、临床反流情况以及不良事件开展荟萃分析。<b><i>结果：</i></b> 本研究共纳入8项相关研究，涉及1797例行经口内镜下肌切开术的贲门失弛缓症患者，其中1128例为初治患者，669例为既往内镜治疗失败患者。在既往内镜治疗失败组中，技术成功率的合并估算值为97.7%（95%置信区间[CI]：95.8%~98.8%），临床成功率为91.0%（95%CI：88.0%~93.4%），不良事件发生率为23.5%（95%CI：10.6%~44.1%）。该组患者的Eckardt评分较基线显著降低5.95分（95%CI：5.50~6.40，<i>p</i> < 0.00001），食管下括约肌压力显著降低19.74mmHg（95%CI：14.10~25.39，<i>p</i> < 0.00001）。初治组与既往内镜治疗失败组在技术成功率、临床成功率及不良事件发生率上均无显著差异，对应的风险比分别为1.0（95%CI：0.99~1.01，<i>p</i> = 0.89）、1.02（95%CI：0.98~1.06，<i>p</i> = 0.36）与0.88（95%CI：0.67~1.16，<i>p</i> = 0.38）。<b><i>结论：</i></b> 经口内镜下肌切开术对于既往接受过内镜治疗的贲门失弛缓症患者而言，是一种安全有效的治疗手段。未来仍需开展随机对照临床试验，进一步验证该术式在该类患者中的有效性与安全性。