PMID- 30851179
OWN - NLM
STAT- MEDLINE
DCOM- 20190826
LR  - 20190826
IS  - 1842-1121 (Electronic)
IS  - 1841-8724 (Linking)
VI  - 28
IP  - 1
DP  - 2019 Mar
TI  - Anterior versus posterior myotomy during poem for the treatment of achalasia: 
      systematic review and meta-analysis of randomized clinical trials.
PG  - 107-115
LID - 10.15403/jgld.2014.1121.281.pom [doi]
AB  - BACKGROUND AND AIMS: The optimal orientation of the myotomy during peroral 
      endoscopic myotomy (POEM) is unknown. This meta-analysis aims to compare anterior 
      and posterior myotomy regarding clinical success and safety. METHODS: PubMed, 
      Embase, Cochrane Library, WOK, and clinicaltrials.gov were searched to identify 
      randomized clinical trials (RCTs) comparing anterior and posterior myotomy during 
      POEM for the treatment of achalasia. The primary outcome was clinical success. 
      Secondary outcomes included postprocedural gastroesophageal reflux disease 
      (GERD), adverse events (AEs), manometric findings, and procedure-related 
      parameters. Random-effects models were used for the primary analysis. RESULTS: 
      Four RCTs enrolling 488 patients were included. Overall clinical success 3-12 
      months after POEM was 97% (95% confidence interval [CI] 93-100%) and did not 
      differ between anterior and posterior myotomy (Relative risk [RR] 0.98, 95%CI: 
      0.96-1.01; I2: 0%). Incidence of GERD after POEM based on 24-hour pH monitoring 
      (RR 0.98, 95%CI: 0.75-1.28), endoscopy (RR 1.04, 95%CI: 0.78-1.38), and symptoms 
      (RR 0.89, 95%CI: 0.55-1.42) was similar. Posterior myotomy was associated with 
      fewer AEs (RR 0.63, 95%CI: 0.42-0.94), lower risk of mucosotomy (RR 0.42, 95%CI: 
      0.27-0.66) and shorter incision closure time (mean difference: -2.28 minutes, 
      95%CI: -3.46 to -1.10). Anterior myotomy was associated with a shorter length of 
      hospitalization (mean difference: 0.31 days, 95%CI: 0.05-0.57), although the 
      clinical relevance of this finding is negligible. No significant differences were 
      found regarding manometric outcomes, total operation and myotomy time. 
      CONCLUSIONS: Anterior and posterior myotomy are equally effective for the 
      treatment of achalasia, without significant differences in postprocedural GERD. 
      Posterior POEM was associated with fewer AEs and a shorter incision closure time.
FAU - Rodriguez de Santiago, Enrique
AU  - Rodriguez de Santiago E
AD  - Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Tokyo, 
      Japan;Gastroenterology and Hepatology Department, Hospital Universitario Ramon y 
      Cajal. University of Alcala. Instituto Ramon y Cajal de Investigacion Sanitaria, 
      Madrid, Spain.e_rodriguez_de_santiago@hotmail.com.
FAU - Mohammed, Noor
AU  - Mohammed N
AD  - Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Tokyo, 
      Japan;Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, 
      United Kingdom.
FAU - Manolakis, Anastassios
AU  - Manolakis A
AD  - Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Tokyo, 
      Japan;Department of Gastroenterology, Larissa University Hospital, Larissa, 
      Greece.
FAU - Shimamura, Yuto
AU  - Shimamura Y
AD  - Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Tokyo, Japan.
FAU - Onimaru, Manabu
AU  - Onimaru M
AD  - Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Tokyo, Japan.
FAU - Inoue, Haruhiro
AU  - Inoue H
AD  - Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Tokyo, Japan.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - Romania
TA  - J Gastrointestin Liver Dis
JT  - Journal of gastrointestinal and liver diseases : JGLD
JID - 101272825
MH  - Adult
MH  - Esophageal Achalasia/diagnosis/physiopathology/*surgery
MH  - Esophagus/physiopathology/*surgery
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/etiology
MH  - Pyloromyotomy/adverse effects/*methods
MH  - Randomized Controlled Trials as Topic
MH  - Recovery of Function
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2019/03/10 06:00
MHDA- 2019/08/27 06:00
CRDT- 2019/03/10 06:00
PHST- 2019/03/10 06:00 [entrez]
PHST- 2019/03/10 06:00 [pubmed]
PHST- 2019/08/27 06:00 [medline]
AID - 16 [pii]
AID - 10.15403/jgld.2014.1121.281.pom [doi]
PST - ppublish
SO  - J Gastrointestin Liver Dis. 2019 Mar;28(1):107-115. doi: 
      10.15403/jgld.2014.1121.281.pom.