CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(08): E1246-E1254
DOI: 10.1055/a-1490-8493
Original article

Short versus standard esophageal myotomy in achalasia patients: a systematic review and meta-analysis of comparative studies

Saurabh Chandan
 1  Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
,
Antonio Facciorusso
 2  Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
,
Shahab R. Khan
 3  Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, United States
,
Daryl Ramai
 4  Internal Medicine, Brooklyn Hospital Center, Brooklyn, New York, United States
,
Babu P. Mohan
 5  Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Mohammad Bilal
 6  Division of Gastroenterology, University of Minnesota and Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
,
Banreet Dhindsa
 7  Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Lena L. Kassab
 8  Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
,
Hemant Goyal
 9  Gastroenterology, Wright Center for Graduate Medical Education, Scranton, Philadelphia, United States
,
Abhilash Perisetti
10  Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
,
Ishfaq Bhat
 7  Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Shailender Singh
 7  Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Stephanie McDonough
 5  Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
,
Douglas G. Adler
 5  Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
› Author Affiliations

Abstract

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.

Supplementary material



Publication History

Received: 14 December 2020

Accepted: 17 March 2021

Publication Date:
16 July 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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