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

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.

Research hotspots and trend of a emerging novel endoscopic technique of peroral endoscopic myotomy from 2010 to 2022: A bibliometric analysis

“…[23,24] In addition, a comparison of the efficacy of various operation methods of POEM has gradually emerged, such as anterior versus posterior direction anterior versus posterior myotomy [25] and short versus standard esophageal myotomy. [26] At the same time, studies on the efficacy of POEM in the treatment of special populations such as the pediatric, [27] the geriatric, [28] the failed Heller myotomy patients, [29] and other esophageal motility disorders patients [30] are also gradually emerging. Recently, the efficacy of the derivative technology of POEM, such as D-POEM for esophageal diverticulum, [31] Z-POEM for Zenker diverticulum, [19] and G-POEM for refractory gastroparesis [20] has gradually become a hot topic.…”

Comparison of fully coated anti-reflux metal stenting and per-oral endoscopic myotomy in patients with achalasia: a propensity score-matched retrospective study

“…Recently, studies showed that the length of circular myotomy is related to the occurrence of GERD complications. Short myotomy is safer and more effective than standard myotomy, which can reduce GERD complications [ 30 ]. It is still need for further study to decrease complications and enhance curative effect.…”

Evolving field of third‐space endoscopy: Derivatives of peroral endoscopic myotomy

“…Regarding esophageal myotomy, a shorter myotomy (3–5 cm) on the esophageal side is comparable to a standard myotomy (7–10 cm) in terms of efficacy and safety. Two recent systematic reviews and meta‐analyses have demonstrated shorter operation time and reduction in the risk of postoperative GERD in a short myotomy group 16,17 . Shorter myotomy is suitable in type I and II patients, especially in type II patients.…”

“…Two recent systematic reviews and meta-analyses have demonstrated shorter operation time and reduction in the risk of postoperative GERD in a short myotomy group. 16,17 Shorter myotomy is suitable in type I and II patients, especially in type II patients. However, we must remember that a longer myotomy is required in type III achalasia or other spastic disorders.…”