Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials
Background: Peroral endoscopic myotomy (POEM) is an established modality of treatment for achalasia cardia. Considerable variations exist in the technique of POEM with respect to the length and orientation of the myotomy. In this systematic review and meta-analysis, we compared the outcomes of short...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | The Saudi Journal of Gastroenterology |
| Subjects: | |
| Online Access: | http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2022;volume=28;issue=4;spage=261;epage=267;aulast= |
| _version_ | 1811341921333805056 |
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| author | Zaheer Nabi Rupjyoti Talukdar Harshal Mandavdhare D Nageshwar Reddy |
| author_facet | Zaheer Nabi Rupjyoti Talukdar Harshal Mandavdhare D Nageshwar Reddy |
| author_sort | Zaheer Nabi |
| collection | DOAJ |
| description | Background: Peroral endoscopic myotomy (POEM) is an established modality of treatment for achalasia cardia. Considerable variations exist in the technique of POEM with respect to the length and orientation of the myotomy. In this systematic review and meta-analysis, we compared the outcomes of short versus long myotomy during POEM.
Methods: We searched multiple databases from January 2010 to March 2021 to identify studies reporting on POEM. We selected studies that reported on comparative outcomes of POEM using short versus long myotomy. We performed a comparative analysis of clinical success, procedural duration, gastroesophageal reflux disease (GERD), and adverse events with short and long myotomy in POEM by meta-analysis.
Results: A total of 521 patients from five studies in which 241 patients were treated with short and 280 patients with long myotomy approaches were analyzed. The pooled rate for clinical success gave an odds ratio (OR) of 1.27 (95% confidence interval [CI] 0.50–3.26; I2 = 0; P = 0.62); for hospital stay OR 0.22 (95% CI − 0.03 to 0.46; I2 = 0; P = 0.08); for GERD by esophagogastroduodenoscopy (EGD) OR 0.58 (95% CI 0.31–1.07; I2 = 0; P = 0.08), and for adverse events OR 0.67 (95% CI 0.29–1.53; I2 = 51; P = 0.34). Abnormal esophageal acid exposure was less frequent with OR 0.45 (95% CI 0.22–0.90; P = 0.02; I2 = 0) and the procedure duration was significantly shorter in the short myotomy group with OR − 0.76 (95% CI − 1.00 to − 0.52; I2 = 43; P =0.001).
Conclusion: Short myotomy and long myotomy in POEM seem comparable with each other in terms of clinical success and adverse events. Short myotomy is associated with significantly shorter procedural duration and possibly reduced esophageal acid exposure compared with long myotomy. |
| first_indexed | 2024-04-13T19:02:20Z |
| format | Article |
| id | doaj.art-557a1cb1e3c64deaa2db6fbf3d853b03 |
| institution | Directory Open Access Journal |
| issn | 1319-3767 1998-4049 |
| language | English |
| last_indexed | 2024-04-13T19:02:20Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | The Saudi Journal of Gastroenterology |
| spelling | doaj.art-557a1cb1e3c64deaa2db6fbf3d853b032022-12-22T02:34:04ZengWolters Kluwer Medknow PublicationsThe Saudi Journal of Gastroenterology1319-37671998-40492022-01-0128426126710.4103/sjg.sjg_438_21Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trialsZaheer NabiRupjyoti TalukdarHarshal MandavdhareD Nageshwar ReddyBackground: Peroral endoscopic myotomy (POEM) is an established modality of treatment for achalasia cardia. Considerable variations exist in the technique of POEM with respect to the length and orientation of the myotomy. In this systematic review and meta-analysis, we compared the outcomes of short versus long myotomy during POEM. Methods: We searched multiple databases from January 2010 to March 2021 to identify studies reporting on POEM. We selected studies that reported on comparative outcomes of POEM using short versus long myotomy. We performed a comparative analysis of clinical success, procedural duration, gastroesophageal reflux disease (GERD), and adverse events with short and long myotomy in POEM by meta-analysis. Results: A total of 521 patients from five studies in which 241 patients were treated with short and 280 patients with long myotomy approaches were analyzed. The pooled rate for clinical success gave an odds ratio (OR) of 1.27 (95% confidence interval [CI] 0.50–3.26; I2 = 0; P = 0.62); for hospital stay OR 0.22 (95% CI − 0.03 to 0.46; I2 = 0; P = 0.08); for GERD by esophagogastroduodenoscopy (EGD) OR 0.58 (95% CI 0.31–1.07; I2 = 0; P = 0.08), and for adverse events OR 0.67 (95% CI 0.29–1.53; I2 = 51; P = 0.34). Abnormal esophageal acid exposure was less frequent with OR 0.45 (95% CI 0.22–0.90; P = 0.02; I2 = 0) and the procedure duration was significantly shorter in the short myotomy group with OR − 0.76 (95% CI − 1.00 to − 0.52; I2 = 43; P =0.001). Conclusion: Short myotomy and long myotomy in POEM seem comparable with each other in terms of clinical success and adverse events. Short myotomy is associated with significantly shorter procedural duration and possibly reduced esophageal acid exposure compared with long myotomy.http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2022;volume=28;issue=4;spage=261;epage=267;aulast=achalasiaendoscopyesophagusmyotomyoutcomes |
| spellingShingle | Zaheer Nabi Rupjyoti Talukdar Harshal Mandavdhare D Nageshwar Reddy Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials The Saudi Journal of Gastroenterology achalasia endoscopy esophagus myotomy outcomes |
| title | Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials |
| title_full | Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials |
| title_fullStr | Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials |
| title_full_unstemmed | Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials |
| title_short | Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials |
| title_sort | short versus long esophageal myotomy during peroral endoscopic myotomy a systematic review and meta analysis of comparative trials |
| topic | achalasia endoscopy esophagus myotomy outcomes |
| url | http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2022;volume=28;issue=4;spage=261;epage=267;aulast= |
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