PMID- 35432766
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220419
IS  - 1948-9366 (Print)
IS  - 1948-9366 (Electronic)
VI  - 14
IP  - 3
DP  - 2022 Mar 27
TI  - Peroral endoscopic longer vs shorter esophageal myotomy for achalasia treatment: 
      A systematic review and meta-analysis.
PG  - 247-259
LID - 10.4240/wjgs.v14.i3.247 [doi]
AB  - BACKGROUND: Peroral endoscopic myotomy (POEM) has been demonstrated to be safe 
      and effective in the treatment of achalasia. Longer myotomy is the standard POEM 
      procedure for achalasia but when compared with shorter myotomy, its effectiveness 
      is not as well known. AIM: To compare the clinical effectiveness of longer and 
      shorter myotomy. METHODS: PubMed, EmBase, Cochrane Library, web of science and 
      clinicaltrials.gov were queried for studies comparing shorter and longer POEM for 
      achalasia treatment. The primary outcome was clinical success rate. Secondary 
      outcomes comprised of operative time, adverse events (AEs) rate, gastroesophageal 
      reflux disease (GERD) and procedure-related parameters. The Mantel-Haenszel 
      fixed-effects model was primarily used for the analysis. Publication bias was 
      assessed. RESULTS: Six studies were included in this analysis with a total of 514 
      participants. During the follow-up period of 1-28.7 mo, longer and shorter 
      myotomy in treating achalasia showed similar excellent effectiveness [overall 
      clinical success (OR = 1, 95%CI: 0.46-2.17, P = 1, I(2): 0%; subgroup of abstract 
      (OR = 1.19, 95%CI: 0.38 to 3.73; P = 0.76; I(2): 0%); subgroup of full text (OR = 
      0.86 95%CI: 0.30 to 2.49; P = 0.78; I(2): 0%)]. Shorter myotomy had significantly 
      reduced mean operative time compared with the longer procedure. There were no 
      statistically significant differences in AEs rates, including GERD (overall OR = 
      1.21, 95%CI: 0.76-1.91; P = 0.42; I(2): 9%; subgroup of abstract OR = 0.77, 
      95%CI: 0.40-1.47; P = 0.43; I(2): 0%; subgroup of full text OR = 1.91, 95%CI: 
      0.98-3.75; P = 0.06; I(2): 0%), hospital stay (overall MD = -0.07, 95%CI: -0.30 
      to 0.16; P = 0.55; I(2): 24%; subgroup of abstract MD = 0.20, 95%CI: -0.25 to 
      0.65; P = 0.39; I(2): 0; subgroup of full text MD = -0.16, 95%CI: -0.42 to 0.10; 
      P = 0.23; I(2): 42%), and major bleeding (overall OR = 1.25, 95%CI: 0.58-2.71; P 
      = 0.56; I(2): 0%) between the two procedures. These differences remained 
      statistically non-significant in all sensitivity analyses. CONCLUSION: POEM was 
      effective in treating achalasia. Shorter and longer myotomy procedures provided 
      similar therapeutic effects in terms of long-term effectiveness. In addition, 
      shorter myotomy reduced the operative time.
CI  - (c)The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights 
      reserved.
FAU - Weng, Chun-Yan
AU  - Weng CY
AD  - Department of Gastroenterology, The First Clinical Medical College of Zhejiang 
      Chinese Medical University, Hangzhou 310053, Zhejiang Province, China.
FAU - He, Cheng-Hai
AU  - He CH
AD  - Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal 
      University, Hangzhou 310006, Zhejiang Province, China.
FAU - Zhuang, Ming-Yang
AU  - Zhuang MY
AD  - Internal Medicine of Chinese Medicine, The First Clinical Medical College of 
      Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China.
FAU - Xu, Jing-Li
AU  - Xu JL
AD  - Department of Surgery, The First Clinical Medical College of Zhejiang Chinese 
      Medical University, Hangzhou 310053, Zhejiang Province, China.
FAU - Lyu, Bin
AU  - Lyu B
AD  - Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese 
      Medicine University, Hangzhou 310006, Zhejiang Province, China. 
      lvbin@medmail.com.cn.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Gastrointest Surg
JT  - World journal of gastrointestinal surgery
JID - 101532473
PMC - PMC8984519
OTO - NOTNLM
OT  - Endoscopy
OT  - Gastroesophageal reflux disease
OT  - Meta-analysis
OT  - Myotomy
OT  - Peroral endoscopic myotomy
COIS- Conflict-of-interest statement: The authors declare they have no competing 
      financial and non-financial interests.
EDAT- 2022/04/19 06:00
MHDA- 2022/04/19 06:01
PMCR- 2022/03/27
CRDT- 2022/04/18 06:35
PHST- 2021/09/27 00:00 [received]
PHST- 2021/12/09 00:00 [revised]
PHST- 2022/02/16 00:00 [accepted]
PHST- 2022/04/18 06:35 [entrez]
PHST- 2022/04/19 06:00 [pubmed]
PHST- 2022/04/19 06:01 [medline]
PHST- 2022/03/27 00:00 [pmc-release]
AID - 10.4240/wjgs.v14.i3.247 [doi]
PST - ppublish
SO  - World J Gastrointest Surg. 2022 Mar 27;14(3):247-259. doi: 
      10.4240/wjgs.v14.i3.247.