Pneumatic Systems Sr Majumdar Pd: An Overview of the Applications and Advantages of Pneumatic Techno

Background: Achalasia is a rare, chronic and morbid condition with evolving treatment. Peroral endoscopic myotomy (POEM) has gained considerable popularity, but its comparative effectiveness is uncertain. We aim to evaluate the literature comparing POEM to Heller myotomy (HM) and pneumatic dilation (PD) for the treatment of achalasia.

Pneumatic Systems Sr Majumdar Pd

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Achalasia is a rare cause of dysphagia resulting from failed lower esophageal sphincter relaxation and esophageal dysmotility. While its incidence is

A literature search was performed on 9/3/18 using Medline (Ovid, PubMed), Embase, Cochrane Library, Clinicaltrials.gov, and TRIP to identify studies on POEM and either laparoscopic Heller myotomy or pneumatic dilation. A second search of PubMed occurred in December 2019 given the original literature search would no longer be within 12 months of publication, as recommended by the Cochrane Handbook [13]. The PubMed search string is listed in Supplement 2. Given the suspected limited nature of literature available, a wide selection of study designs was deemed acceptable, including randomized control trials (RCTs) and comparative non-randomized studies. The bibliographies of all included studies, excluded systematic reviews, and background studies were hand-searched to identify articles missed by the original search strategy. Animal studies, non-English studies, and non-comparative observational studies were excluded. Studies were limited to 2010 onwards as POEM was first described in 2009 [8]. Outcomes of interest were decided before the literature search and are listed in Supplement 1.

Figure 6. Risk of bias (RoB) for 7 observational studies addressing POEM (per oral endoscopic myotomy) versus PD (pneumatic dilation). Solid fill, striped, and no fill (white) patterns represent low, unclear risk, and high risk of bias, respectively. The bar at the bottom shows what percent of the total 7 observational studies have each type of risk of bias for both the individual domains and for the overall bias.

Fig 7. Short-term (

A 2020 systematic review on PD versus LHM demonstrated that most studies have historically favored LHM with 4 recent studies reaching divergent conclusions presumed due to definition of repeated dilation as a failure or a natural part of this treatment protocol [47]. This consideration pertains to comparisons between POEM and PD as well. While PD requires more interventions due to repeat dilations, these repeat dilations may be interpreted less as a failure and more as an inherent component of pneumatic dilatory therapy. What Pond et al. demonstrates (Table 3) in particular, however, is that POEM still achieves superior dysphagia resolution up to 2 years post-procedure, even when multiple dilations are used. The safety for all three procedures was comparable. There was no difference in mortality, treatment related serious adverse events, perforation, reoperation for complication, or unexpected ICU stay between POEM and HM and no difference in treatment-related serious adverse events between POEM and PD.

Despite the predominantly low-quality observational evidence with the limited randomized data, the observational studies and RCTs in this report are consistent with one another, particularly regarding efficacy and safety which support POEM as an equal and established alternative to Heller myotomy and as a superior choice to pneumatic dilation. As more robust studies are published, future meta-analyses can elucidate whether the favorable effect of POEM over pneumatic dilation can last past 2 years and can tease out the true incidence and clinical relevance of post-POEM reflux.

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Lastly, with overburdened health systems around the world and viral transmission considerations, COVID-19 patients in the outpatient setting (suspected and confirmed) are instructed to come in to the hospital if their respiratory status deteriorates, most often with no oxygen saturation monitoring at home. While this approach may be essential in managing burdened health system resources and caring for the critically sick, it risks a significant delay in oxygen supplementation for patients in the outpatient setting. With the lack of strikingly effective therapeutic modalities to date, inpatient mortality numbers and percentages for COVID-19 patients around the world have been staggering [33,34,35,36,37]. (It is of relevance to note here that even in non-COVID-19 pneumonia outpatients, oxygen saturations less than 92% are known to be associated with major adverse events [38].) 2ff7e9595c