Peroral endoscopic longer vs shorter esophageal myotomy for achalasia treatment: A systematic review and meta-analysis

doi:10.4240/wjgs.v14.i3.247

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World Journal of Gastrointestinal Surgery

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Meta-Analysis

World J Gastrointest Surg. Mar 27, 2022; 14(3): 247-259
Published online Mar 27, 2022. doi: 10.4240/wjgs.v14.i3.247

Table 1 Articles’ features

Ref.	Total sample	Sex, male/female, n	Age, yr	Symptoms duration, yr or mo	MBI	Classification, n (%)	Pre-ECK scores	LESP, mmHg	IRP, mmHg
Familiari et al[15], 2016	LM: 38	NA	NA	NA	NA	NA	NA	NA	NA
Familiari et al[15], 2016	SM: 35	NA	NA	NA	NA	NA	NA	NA	NA
Gao et al[16], 2017	LM: 53	LM: 29/24; SM: 25/22	LM: 37.83 ± 14.36	LM: 5.23 ± 5.87	LM: 19.76 ± 3.07	NA	LM: 6.75 ± 1.86	LM: 43.03 ± 13.73	NA
Gao et al[16], 2017	SM: 47	LM: 29/24; SM: 25/22	SM: 43.96 ± 11.69	SM: 5.30 ± 4.87	SM: 20.25 ± 2.97	NA	SM: 6.34 ± 1.74	SM: 41.93 ± 14.93	NA
Gong et al[17], 2016	LM: 59; SM: 38	Female; LM: 29; SM: 19	LM: 39.8 ± 12.4; SM: 41.5 ± 7.2	LM: 6.5 ± 5.5; SM: 7.9 ± 4.3	LM: 20.7 ± 2.6; SM: 20.1 ± 3.2	ASAC I: LM: 47; SM: 29; II: LM: 11; SM: 7; III: LM: 1; SM: 2; CC I: LM: 21; SM: 12 II: LM: 38; SM: 26	LM: 7.2 ± 2.4; SM: 6.8 ± 1.7	LM: 42.1 ± 12.9; SM: 44.6 ± 13.2	NA
Gu et al[14], 2020	LM: 48; SM: 46	LM: 23/25; SM: 21/25	LM: 42.8 ± 10.2; SM: 43.6 ± 11.4	LM: 4.1(0.3~31.0); SM: 5.0(0.3~34.0）	NA	CC II: LM: 48; SM: 46	LM: 7.1 ± 1.6; SM: 7.5 ± 1.5	LM: 32.4 ± 5.3; SM: 33.5 ± 5.0	LM: 21.5 ± 4.6; SM: 23.2 ± 4.8
Huang et al[13], 2020	LM: 74; SM: 36	Female; LM: 34; SM: 17	LM: 37.7 ± 13.0; SM: 40.8 ± 11.1	LM: 8.9 ± 5.8; SM: 8.8 ± 5.5	LM: 19.4 ± 3.1; SM: 20.3 ± 2.6	ASAC I: LM: 58; SM: 33; II: LM: 15; SM: 2; III: LM: 1; SM: 1; CC I: LM: 26; SM: 12; II: LM: 48; SM: 24	LM: 7.5 ± 1.9; SM: 7.1 ± 1.6	LM: 39.8 ± 13.7; SM: 41.8 ± 14.3	NA
Nabi et al[12],2020	LM: 37; SM: 34	LM: 24/13; SM: 18/16	LM: 41.3 ± 14.4; SM: 40.1 ± 16.8	LM: 3;SM: 3	NA	ASAC I: LM: 13; SM: 12; II: LM: 24; SM: 22	LM: 6.75 ± 1.32; SM: 6.02 ± 1.33	NA	LM: 28.50 ± 11.01; SM: 26.40 ± 13.9

Data are presented as mean ± standard deviation or n (%). ASAC: American Society of Anesthesiologists classification; BMI: Body mass index; CC: Chicago classification; IRP: Integrated relaxation pressure; LESP: Lower esophagus sphincter pressure; LM: Long myotomy; NA: Not Applied; Pre-ECK scores: Preoperative- peroral endoscopic myotomy Eckardt scores; SM: Short myotomy.

Table 2 The detailed study quality evaluation items

Ref.	Follow-up sample	Length of the myotomy, cm	Operative time, min	Myotomy length, cm	Follow-up time, mo	Clinical success	GERD, %	LESP, mmHg	HRM, mmHg	Post-ECK scores	Adverse events
Familiari et al[15]_,2016	LM: 23 SM: 26	LM: 13 SM: 8	LM: 59.2 ± 16.7 SM: 47.7 ± 13.2	ES: LM: 8.42 ± 2.13 SM: 3.87 ± 0.61 ST: LM: 2.49 ± 0.70 SM: 2.21 ± 0.41 TO: LM: 10.94 ± 2.11 SM: 6.04 ± 0.69	8	LM: 100% SM: 100%	LM: 42.9% SM: 65%	LM: 17 ± 9.7 SM: 11.4 ± 6.5	LM: 8.6 ± 4.9 SM: 5.9 ± 5.0	LM: 0.5 ± 0.8 SM: 0.5 ± 0.8	No
Gao et al[16]_,2017	LM: 53 SM: 47	LM: > 7 SM: ≤7	LM: 63.13 ± 26.5 SM: 50.62 ± 20.02	NA	3,6,12	LM: 96.2% SM: 93.6%	LM: 11.3% SM: 12.8%	LM: 16.51 ± 5.01 SM: 17.41 ± 3.69	NA	LM: 0.98 ± 1.14 SM: 1.06 ± 1.42	MB: LM: 0, SM: 0 MP: LM: 1; SM: 0 HS: LM: 10.19 ± 4.03 SM: 10.21 ± 3.78
Gong et al[17]_,2016	LM: 59 SM: 38	LM: > 7 SM: ≤7	LM: 68.5 ± 23.2 SM: 44.2 ± 16.3	ES: LM: 8.5 ± 2.6 SM: 4.0 ± 0.9 ST: LM: 3.2 ± 1.4 SM: 2.1+0.3 TO: LM: 11.7 ± 2.4 SM: 6.1 ± 0.5	NA	LM: 91.5% SM: 92.1%	LM: 18.6% SM: 15.8%	LM: 19.3 ± 8.5 SM: 16.7 ± 4.3	NA	LM: 1.2 ± 1.2 SM: 1.0 ± 0.9	MB: LM: 3; SM: 2 MP: LM: 1; SM: 0 HS: LM: 6.6 ± 1.1 SM: 6.4 ± 1.2
Gu et al[14]_,2020	LM: 48 SM: 46	LM: 7-8 SM: 3-4	LM: 45.6 ± 16.2 SM: 31.2 ± 15.3	ES: LM: 10.14 ± 0.54 SM: 5.66 ± 0.14	1,3,6,12	LM: 93.8% SM: 95.7%	LM: 22.9% SM: 15.2%	LM: 12.1 ± 3.9 SM: 11.8 ± 4.4	LM: 9.7 ± 2.6 SM: 10.1 ± 2.4	LM: 0.72 ± 0.42 SM: 0.76 ± 0.51	HS: LM: 6: 5 ± 1.6 SM: 7.0 ± 0.9
Huang et al[13]_,2020	LM: 74 SM: 36	LM > 7 SM≤ 7	LM: 62.1 ± 25.2 SM: 46.6 ± 18.5	ES: LM: 8.2 ± 2.7 SM: 4.0 ± 0.7 ST: LM: 3.2 ± 1.2 SM: 3.2 ± 1.2 TO: LM: 11.5 ± 3.1 SM: 6.0 ± 0.6	28.7	LM: 91.9% SM: 94.4%	LM: 14.9% SM: 8.3%	LM: 13.3 ± 5.7 SM: 15.9 ± 3.2	NA	LM: 1.6 ± 1.3 SM: 1.3 ± 1.2	MB: LM: 3; SM: 2 MP: LM: 1; SM: 0 HS: LM: 9.3 ± 2.9 SM: 9.9 ± 2.4
Nabi et al[12], 2020	LM: 37 SM: 34	LM: ≥ 6 SM: ≤ 3	LM: 72.43 ± 27.28 SM: 44.03 ± 13.78	ES: LM: 7.97 ± 2.40 SM: 2.76 ± 0.41 ST: LM: 2.84 ± 0.63 SM: 2.70 ± 0.73	12	LM: 96.97% SM: 93.55%	LM: 56.67%SM: 44.4%	NA	LM: 7.44 ± 4.30 SM: 8.60 ± 1.30	LM: 0.818 ± 0.983 SM: 0.935 ± 0.929	MB: LM: 17; SM: 12 HS: LM: 2.81 ± 0.70 SM: 2.82 ± 0.67

Data are presented as mean ± standard deviation or n (%). Eck: Eckardt score; ES: Esophageal; HS: Hospitalization, mean days; MB: Major bleeding; MP: Mucosal perforation; Post-ECK scores: Postoperative- peroral endoscopic myotomy Eckardt scores; POEM: Peroral endoscopic myotomy; GERD: Gastroesophageal reflux disease; LM: Long myotomy; NA: Not Applied; SM: Short myotomy; ST: Stomach; TO: Total.

Citation: Weng CY, He CH, Zhuang MY, Xu JL, Lyu B. Peroral endoscopic longer vs shorter esophageal myotomy for achalasia treatment: A systematic review and meta-analysis. World J Gastrointest Surg 2022; 14(3): 247-259
URL: https://www.wjgnet.com/1948-9366/full/v14/i3/247.htm
DOI: https://dx.doi.org/10.4240/wjgs.v14.i3.247