Chandan Saurabh, Facciorusso Antonio, Khan Shahab R, Ramai Daryl, Mohan Babu P, Bilal Mohammad, Dhindsa Banreet, Kassab Lena L, Goyal Hemant, Perisetti Abhilash, Bhat Ishfaq, Singh Shailender, McDonough Stephanie, Adler Douglas G
Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States.
Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy.
Endosc Int Open. 2021 Aug;9(8):E1246-E1254. doi: 10.1055/a-1490-8493. Epub 2021 Jul 16.
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. 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. 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 %; = 0.69), postoperative symptomatic GERD (OR 0.87, 95 %CI 0.44-1.74; I2 29 %; = 0.70), and overall adverse events (OR 0.52, 95 %CI 0.19-1.38; I2 40 %; = 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 %; = 0.06). 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.
尽管经口内镜下肌切开术（POEM）具有临床疗效，但术后症状性胃食管反流病（GERD）仍然是一个主要问题。虽然已知胃肌切开术的长度会影响术后GERD，但食管肌切开术长度变化的临床相关性尚不清楚。我们对比较贲门失弛缓症患者短肌切开术与标准肌切开术结果的研究进行了系统评价和荟萃分析。我们检索了从数据库创建到2020年11月的多个数据库，以确定报告了接受短食管肌切开术与标准食管肌切开术的贲门失弛缓症患者结果的研究。进行荟萃分析以确定两种技术在临床成功、GERD结果和不良事件方面的合并比值比（OR）。最终分析纳入了5项研究共474例患者（短肌切开术组214例，标准肌切开术组260例）。两组在临床成功率（OR 1.17，95%置信区间[CI]0.54 - 2.52；I² 0%；P = 0.69）、术后症状性GERD（OR 0.87，95%CI 0.44 - 1.74；I² 29%；P = 0.70）和总体不良事件（OR 0.52，95%CI 0.19 - 1.38；I² 40%；P = 0.19）方面没有差异。内镜检查确定的术后糜烂性食管炎发生率在短肌切开术组较低（OR 0.50，95%CI 0.24 - 1.03；I² 0%；P = 0.06）。我们的分析表明，在贲门失弛缓症患者中进行短食管肌切开术的POEM与标准肌切开术一样安全有效，且术后糜烂性食管炎的发生率较低。
