Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2022; 14(3): 247-259
Published online Mar 27, 2022. doi: 10.4240/wjgs.v14.i3.247
Peroral endoscopic longer vs shorter esophageal myotomy for achalasia treatment: A systematic review and meta-analysis
Chun-Yan Weng, Cheng-Hai He, Ming-Yang Zhuang, Jing-Li Xu, Bin Lyu
Chun-Yan Weng, Department of Gastroenterology, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Cheng-Hai He, Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310006, Zhejiang Province, China
Ming-Yang Zhuang, Internal Medicine of Chinese Medicine, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Jing-Li Xu, Department of Surgery, The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Bin Lyu, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou 310006, Zhejiang Province, China
Author contributions: Weng CY and He CH collected data; Zhuang MY analyzed the data and wrote the first draft of the manuscript; Xu JL and Lyu B were major contributors in editing the manuscript; All authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 8177030774.
Conflict-of-interest statement: The authors declare they have no competing financial and non-financial interests.
PRISMA 2009 Checklist statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Lyu, PhD, Professor, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medicine University, No. 54 Youdian Road, Hangzhou 310006, Zhejiang Province, China. lvbin@medmail.com.cn
Received: September 27, 2021
Peer-review started: September 27, 2021
First decision: December 4, 2021
Revised: December 9, 2021
Accepted: February 16, 2022
Article in press: February 16, 2022
Published online: March 27, 2022
Abstract
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, I2: 0%; subgroup of abstract (OR = 1.19, 95%CI: 0.38 to 3.73; P = 0.76; I2: 0%); subgroup of full text (OR = 0.86 95%CI: 0.30 to 2.49; P = 0.78; I2: 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; I2: 9%; subgroup of abstract OR = 0.77, 95%CI: 0.40-1.47; P = 0.43; I2: 0%; subgroup of full text OR = 1.91, 95%CI: 0.98-3.75; P = 0.06; I2: 0%), hospital stay (overall MD = -0.07, 95%CI: -0.30 to 0.16; P = 0.55; I2: 24%; subgroup of abstract MD = 0.20, 95%CI: -0.25 to 0.65; P = 0.39; I2: 0; subgroup of full text MD = -0.16, 95%CI: -0.42 to 0.10; P = 0.23; I2: 42%), and major bleeding (overall OR = 1.25, 95%CI: 0.58-2.71; P = 0.56; I2: 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.

Keywords: Endoscopy, Meta-analysis, Myotomy, Peroral endoscopic myotomy, Gastroesophageal reflux disease

Core Tip: We evaluated the peroral endoscopic longer vs shorter myotomy for achalasia treatment in our study. To our knowledge, this is the first meta-analysis aiming to compare longer and shorter myotomy during peroral endoscopic myotomy for the treatment of achalasia regarding clinical success, safety and procedure-related outcomes. Shorter and longer myotomy procedures showed similar therapeutic effects in terms of long-term effectiveness. In addition, shorter myotomy reduced the operative time.