Abstract Background Gastroesophageal reflux is a major complication of post-POEM (peroral endoscopic myotomy, POEM) for esophageal achlasia. Objective: To discuss the effects of three measuring methods for Gastroesophageal Reflux of Post-POEM Achalasia Patients and find out the best method for diagnosing post-POEM gastroesophageal reflux of esophageal achalasia patients by conducting clinical follow-up studies. Methods: Follow-up visits were conducted on the patients with esophageal achalasia who had received POEM treatment in our hospital from 2013 to 2016. Between 2 to 4 weeks post operation, Eckardt score was adopted to evaluate the operation efficacy, the GerdQ score, electronic gastroscopy and 24h esophagus impedance-pH monitoring to investigate the gastroesophageal reflux and the comparison of detection rate among the three different methods on post-POEM gastroesophageal reflux. Results: There were 76 patients with Eckardt scores were 3 or lower than 3 post POEM (76/78, 97.44%), 2 patients with Eckardt scores were 4 or higher than 4 (2/78, 2.56%), the cure rate of the treatment was as high as 97.44%; the Eckardt score post operation decreased more significantly than before operation, P<0.0.5. Conclusion: for post-POEM Achalasia patients, 24h esophagus impedance-pH monitoring is the best way to diagnose post-POEM gastroesophageal reflux.

The present systematic review and meta-analysis aimed to evaluate the available evidence base on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) combined with either endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or endoscopic ultrasound using the EBUS scope-guided fine-needle aspiration (EUS-B-FNA) for diagnosing and staging mediastinal diseases. PubMed, Web of Science, and Embase were searched to identify suitable studies up to June 30, 2019. Two investigators independently reviewed articles and extracted relevant data. Data were pooled using random effect models to calculate diagnostic indices that included sensitivity and specificity. Summary receiver operating characteristic (SROC) curves were used to summarize the overall test performance. Data pooled from up to 16 eligible studies (including 10 studies of 963 patients about EBUS-TBNA with EUS-FNA and six studies of 815 patients with EUS-B-FNA) indicated that combining EBUS-TBNA with EUS-FNA was associated with slightly better diagnostic accuracy than combining it with EUS-B-FNA, in terms of sensitivity (0.87, 95%CI 0.83 to 0.90 vs. 0.84, 95%CI 0.80 to 0.88), specificity (1.00, 95%CI 0.99 to 1.00 vs. 0.96, 95%CI 0.93 to 0.97), diagnostic odds ratio (413.39, 95%CI 179.99 to 949.48 vs. 256.38, 95%CI 45.48 to 1445.32), and area under the SROC curve (0.99, 95%CI 0.97 to 1.00 vs. 0.97, 95%CI 0.92 to 1.00). The current evidence suggests that the combination of EBUS-TBNA with either EUS-FNA or EUS-B-FNA provides relatively high accuracy for diagnosing mediastinal diseases. The combination with EUS-FNA may be slightly better.