Safety and Efficacy of Peroral Endoscopic Shorter Myotomy versus Longer Myotomy for Patients with Achalasia: A Systematic Review and Meta-analysis
Background and Aims. The adequate myotomy length during peroral endoscopic myotomy (POEM) is still controversial. We performed this systematic review and meta-analysis to determine the efficacy and safety of the modified POEM with shorter myotomy (SM) and compare the outcomes between SM and longer m...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-01-01
|
| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2022/6770864 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832565469938188288 |
|---|---|
| author | Han Zhang Xinyi Zeng Shu Huang Huifang Xia Lei Shi Jiao Jiang Wensen Ren Yan Peng Muhan Lü Xiaowei Tang |
| author_facet | Han Zhang Xinyi Zeng Shu Huang Huifang Xia Lei Shi Jiao Jiang Wensen Ren Yan Peng Muhan Lü Xiaowei Tang |
| author_sort | Han Zhang |
| collection | DOAJ |
| description | Background and Aims. The adequate myotomy length during peroral endoscopic myotomy (POEM) is still controversial. We performed this systematic review and meta-analysis to determine the efficacy and safety of the modified POEM with shorter myotomy (SM) and compare the outcomes between SM and longer myotomy (LM) in achalasia patients. Methods. A comprehensive literature search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science databases from inception to May 28, 2021. The primary outcome was clinical success rate and incidence of reflux-relative adverse events (AEs). Fixed- or random-effect models were adopted for the analysis according to the heterogeneity. Results. Five studies involving 225 patients in SM group and 222 patients in LM group were included. The overall clinical success of SM was 96.6% (95% confidence interval (CI) 92.7 to 98.4%). SM showed noninferior response as compared to LM (risk ratio (RR) 1.02, 95% CI 0.98 to 1.06, P=0.41, I2=0%). Based on the abnormal acid reflux by pH monitoring, its incidence was significantly lower in the SM group than that in the LM group (RR 0.58, 95% CI 0.36 to 0.94, P=0.03, I2=0%). With respect to procedure-related parameters, the total procedure time of SM was significantly shorter than that of LM (mean difference (MD) -16.30, 95% CI -23.10 to -9.49, P<0.001, I2=68%). Conclusions. SM and LM are comparable in providing treatment efficacy for achalasia patients, whereas less operation time and lower incidence of post-POEM abnormal esophageal acid exposure are observed in SM. |
| format | Article |
| id | doaj-art-be7572f1ba68430e885b49383ee1d990 |
| institution | Kabale University |
| issn | 1687-630X |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-be7572f1ba68430e885b49383ee1d9902025-02-03T01:07:45ZengWileyGastroenterology Research and Practice1687-630X2022-01-01202210.1155/2022/6770864Safety and Efficacy of Peroral Endoscopic Shorter Myotomy versus Longer Myotomy for Patients with Achalasia: A Systematic Review and Meta-analysisHan Zhang0Xinyi Zeng1Shu Huang2Huifang Xia3Lei Shi4Jiao Jiang5Wensen Ren6Yan Peng7Muhan Lü8Xiaowei Tang9Department of GastroenterologyDepartment of GastroenterologyDepartment of GastroenterologyDepartment of GastroenterologyDepartment of GastroenterologyDepartment of GastroenterologyDepartment of GastroenterologyDepartment of GastroenterologyDepartment of GastroenterologyDepartment of GastroenterologyBackground and Aims. The adequate myotomy length during peroral endoscopic myotomy (POEM) is still controversial. We performed this systematic review and meta-analysis to determine the efficacy and safety of the modified POEM with shorter myotomy (SM) and compare the outcomes between SM and longer myotomy (LM) in achalasia patients. Methods. A comprehensive literature search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science databases from inception to May 28, 2021. The primary outcome was clinical success rate and incidence of reflux-relative adverse events (AEs). Fixed- or random-effect models were adopted for the analysis according to the heterogeneity. Results. Five studies involving 225 patients in SM group and 222 patients in LM group were included. The overall clinical success of SM was 96.6% (95% confidence interval (CI) 92.7 to 98.4%). SM showed noninferior response as compared to LM (risk ratio (RR) 1.02, 95% CI 0.98 to 1.06, P=0.41, I2=0%). Based on the abnormal acid reflux by pH monitoring, its incidence was significantly lower in the SM group than that in the LM group (RR 0.58, 95% CI 0.36 to 0.94, P=0.03, I2=0%). With respect to procedure-related parameters, the total procedure time of SM was significantly shorter than that of LM (mean difference (MD) -16.30, 95% CI -23.10 to -9.49, P<0.001, I2=68%). Conclusions. SM and LM are comparable in providing treatment efficacy for achalasia patients, whereas less operation time and lower incidence of post-POEM abnormal esophageal acid exposure are observed in SM.http://dx.doi.org/10.1155/2022/6770864 |
| spellingShingle | Han Zhang Xinyi Zeng Shu Huang Huifang Xia Lei Shi Jiao Jiang Wensen Ren Yan Peng Muhan Lü Xiaowei Tang Safety and Efficacy of Peroral Endoscopic Shorter Myotomy versus Longer Myotomy for Patients with Achalasia: A Systematic Review and Meta-analysis Gastroenterology Research and Practice |
| title | Safety and Efficacy of Peroral Endoscopic Shorter Myotomy versus Longer Myotomy for Patients with Achalasia: A Systematic Review and Meta-analysis |
| title_full | Safety and Efficacy of Peroral Endoscopic Shorter Myotomy versus Longer Myotomy for Patients with Achalasia: A Systematic Review and Meta-analysis |
| title_fullStr | Safety and Efficacy of Peroral Endoscopic Shorter Myotomy versus Longer Myotomy for Patients with Achalasia: A Systematic Review and Meta-analysis |
| title_full_unstemmed | Safety and Efficacy of Peroral Endoscopic Shorter Myotomy versus Longer Myotomy for Patients with Achalasia: A Systematic Review and Meta-analysis |
| title_short | Safety and Efficacy of Peroral Endoscopic Shorter Myotomy versus Longer Myotomy for Patients with Achalasia: A Systematic Review and Meta-analysis |
| title_sort | safety and efficacy of peroral endoscopic shorter myotomy versus longer myotomy for patients with achalasia a systematic review and meta analysis |
| url | http://dx.doi.org/10.1155/2022/6770864 |
| work_keys_str_mv | AT hanzhang safetyandefficacyofperoralendoscopicshortermyotomyversuslongermyotomyforpatientswithachalasiaasystematicreviewandmetaanalysis AT xinyizeng safetyandefficacyofperoralendoscopicshortermyotomyversuslongermyotomyforpatientswithachalasiaasystematicreviewandmetaanalysis AT shuhuang safetyandefficacyofperoralendoscopicshortermyotomyversuslongermyotomyforpatientswithachalasiaasystematicreviewandmetaanalysis AT huifangxia safetyandefficacyofperoralendoscopicshortermyotomyversuslongermyotomyforpatientswithachalasiaasystematicreviewandmetaanalysis AT leishi safetyandefficacyofperoralendoscopicshortermyotomyversuslongermyotomyforpatientswithachalasiaasystematicreviewandmetaanalysis AT jiaojiang safetyandefficacyofperoralendoscopicshortermyotomyversuslongermyotomyforpatientswithachalasiaasystematicreviewandmetaanalysis AT wensenren safetyandefficacyofperoralendoscopicshortermyotomyversuslongermyotomyforpatientswithachalasiaasystematicreviewandmetaanalysis AT yanpeng safetyandefficacyofperoralendoscopicshortermyotomyversuslongermyotomyforpatientswithachalasiaasystematicreviewandmetaanalysis AT muhanlu safetyandefficacyofperoralendoscopicshortermyotomyversuslongermyotomyforpatientswithachalasiaasystematicreviewandmetaanalysis AT xiaoweitang safetyandefficacyofperoralendoscopicshortermyotomyversuslongermyotomyforpatientswithachalasiaasystematicreviewandmetaanalysis |