TY - JOUR
T1 - Short versus standard esophageal myotomy in achalasia patients
T2 - A systematic review and meta-analysis of comparative studies
AU - Chandan, Saurabh
AU - Facciorusso, Antonio
AU - Khan, Shahab R.
AU - Ramai, Daryl
AU - Mohan, Babu P.
AU - Bilal, Mohammad
AU - Dhindsa, Banreet
AU - Kassab, Lena L.
AU - Goyal, Hemant
AU - Perisetti, Abhilash
AU - Bhat, Ishfaq
AU - Singh, Shailender
AU - McDonough, Stephanie
AU - Adler, Douglas G.
N1 - Publisher Copyright:
© 2021 Georg Thieme Verlag. All rights reserved.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Background and study aims Despite the clinical efficacy of peroral endoscopic myotomy (POEM), postoperative symptomatic gastroesophageal reflux disease (GERD) remains a major concern. While it is known that length of the gastric myotomy affects postoperative GERD, the clinical relevance of variation in esophageal myotomy length is not well known. We performed a systematic review and meta-analysis of studies comparing outcomes of short versus standard myotomy length in patients with achalasia. Patients and methods We searched multiple databases from inception through November 2020 to identify studies that reported on outcomes of achalasia patients who underwent short compared with standard esophageal myotomy. Meta-analysis was performed to determine pooled odds ratio (OR) of clinical success, GERD outcomes, and adverse events with the two techniques. Results 5 studies with 474 patients were included in the final analysis (short myotomy group 214, standard myotomy group 260). There was no difference in clinical success (OR 1.17, 95% confidence interval [CI] 0.54-2.52; I2 0%; P =0.69), postoperative symptomatic GERD (OR 0.87, 95%CI 0.44-1.74; I2 29%; P =0.70), and overall adverse events (OR 0.52, 95%CI 0.19-1.38; I2 40%; P =0.19), between the two groups. Incidence of postoperative erosive esophagitis as determined by endoscopy was lower in the short myotomy group (OR 0.50, 95%CI 0.24-1.03; I2 0%; P =0.06). Conclusion Our analysis showed that performing POEM with short esophageal myotomy in achalasia was as safe and effective as standard myotomy, with lower incidence of postoperative erosive esophagitis.
AB - Background and study aims Despite the clinical efficacy of peroral endoscopic myotomy (POEM), postoperative symptomatic gastroesophageal reflux disease (GERD) remains a major concern. While it is known that length of the gastric myotomy affects postoperative GERD, the clinical relevance of variation in esophageal myotomy length is not well known. We performed a systematic review and meta-analysis of studies comparing outcomes of short versus standard myotomy length in patients with achalasia. Patients and methods We searched multiple databases from inception through November 2020 to identify studies that reported on outcomes of achalasia patients who underwent short compared with standard esophageal myotomy. Meta-analysis was performed to determine pooled odds ratio (OR) of clinical success, GERD outcomes, and adverse events with the two techniques. Results 5 studies with 474 patients were included in the final analysis (short myotomy group 214, standard myotomy group 260). There was no difference in clinical success (OR 1.17, 95% confidence interval [CI] 0.54-2.52; I2 0%; P =0.69), postoperative symptomatic GERD (OR 0.87, 95%CI 0.44-1.74; I2 29%; P =0.70), and overall adverse events (OR 0.52, 95%CI 0.19-1.38; I2 40%; P =0.19), between the two groups. Incidence of postoperative erosive esophagitis as determined by endoscopy was lower in the short myotomy group (OR 0.50, 95%CI 0.24-1.03; I2 0%; P =0.06). Conclusion Our analysis showed that performing POEM with short esophageal myotomy in achalasia was as safe and effective as standard myotomy, with lower incidence of postoperative erosive esophagitis.
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U2 - 10.1055/a-1490-8493
DO - 10.1055/a-1490-8493
M3 - Review article
C2 - 34447872
AN - SCOPUS:85113908559
SN - 2196-9736
VL - 9
SP - E1246-E1254
JO - Endoscopy International Open
JF - Endoscopy International Open
IS - 8
ER -