Comparative efficacy of per-oral endoscopic myotomy and Heller myotomy in patients with achalasia: a meta-analysis
- Authors
- Park, Chan Hyuk; Jung, Da Hyun; Kim, Do Hoon; Lim, Chul-Hyun; Moon, Hee Seok; Park, Jung Ho; Jung, Hye-Kyung; Hong, Su Jin; Choi, Suck Chei; Lee, Oh Young
- Issue Date
- Oct-2019
- Publisher
- MOSBY-ELSEVIER
- Citation
- GASTROINTESTINAL ENDOSCOPY, v.90, no.4, pp.546 - 558.e3
- Indexed
- SCIE
SCOPUS
- Journal Title
- GASTROINTESTINAL ENDOSCOPY
- Volume
- 90
- Number
- 4
- Start Page
- 546
- End Page
- 558.e3
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/12512
- DOI
- 10.1016/j.gie.2019.05.046
- ISSN
- 0016-5107
- Abstract
- Background and Aims: Although both per-oral endoscopic myotomy (POEM) and Heller myotomy (HM) have been used for the treatment of achalasia, the comparative efficacy of POEM and HM has yet to be fully evaluated.
Methods: We searched all relevant studies published up to September 2018 examining the comparative efficacy between POEM and HM. Study quality was assessed using the Newcastle-Ottawa scale. Meta-analyses for Eckardt scores, perioperative outcomes, and reflux-related outcomes were performed based on a random-effects model.
Results: Fifteen studies with a total of 1213 patients were evaluated. The follow-up duration ranged from 2 to 46.2 months and from 2 to 54.2 months in the POEM and HM groups, respectively. Postoperative Eckardt scores were lower (better) in the POEM group than in the HM group (pooled standardized mean difference [SMD], - 0.58; 95% confidence interval [CI], - 1.03 to - 0.13). Length of myotomy was greater in the POEM group than in the HM group (pooled SMD, 0.63; 95% CI, 0.42-0.84). There was no difference in reflux symptoms and pathologic reflux on pH monitoring between the groups (pooled risk ratio [RR], 1.03; 95% CI, 0.61-1.73; and pooled RR, 1.22; 95% CI, 0.67-2.25, respectively). Erosive esophagitis on endoscopy tended to be less common in the HM group (pooled RR, 1.88; 95% CI, 0.98-3.62).
Conclusion: Although long-term follow-up data are insufficient, the short-term efficacy of POEM was superior to that of HM. Erosive esophagitis tended to be more common in the POEM group; however, there was no difference in reflux symptoms and pathologic reflux on pH monitoring between the groups.
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