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
ARTICLE HIGHLIGHTS
Research background

For a long time, peroral endoscopic myotomy (POEM) has been demonstrated to be safe and effective in the treatment of achalasia.

Research motivation

Longer myotomy is the standard POEM procedure for achalasia, but its effectiveness compared with shorter myotomy is not well known. Thus, we want to provide an analysis to assess the clinical outcomes of shorter and longer myotomy.

Research objectives

To conduct a meta-analysis to compare the clinical effectiveness of the two procedures.

Research methods

The PubMed, Web of Science, Cochrane Library, clinicaltrials.gov, and EMBASE databases were used to search for relevant studies to compare shorter and longer myotomy in POEM for achalasia treatment.

Research results

Longer and shorter myotomy groups in treating achalasia had similar excellent effectiveness. Shorter myotomy had significantly reduced mean operative time compared with the longer procedure. There were no statistically significant differences in AE’s rates, including gastroesophageal reflux diseases, hospital stay and major bleeding between the two procedures.

Research conclusions

Short myotomy has the advantage of shorter procedure time in the treatment of achalasia compared to long myotomy, but the clinical success rate, adverse events , and reflux rate were comparable.

Research perspectives

Future randomized clinical trials should determine whether the benefits remain comparable after years of follow-up.