Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Department of General Surgery, São João University Hospital Center, Porto, Portugal.
Esophagus. 2024 Jul;21(3):298-305. doi: 10.1007/s10388-024-01063-x. Epub 2024 May 22.
There are various therapeutic options for achalasia. Nevertheless, peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy with fundoplication (LHM) are distinguished by their efficacy and low incidence of complications. Compare POEM and LHM regarding several outcomes in patients with achalasia. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An exhaustive literature search was performed using PubMed, Web of Science, and Cochrane Library databases. Studies comparing several outcomes between POEM and LHM in patients with achalasia were included. Data on clinical success, operative time, intraoperative complications, length of stay, reintervention rates, postoperative pain, overall complications, occurrence of GERD symptoms, use of proton bomb inhibitors and esophagitis were extracted. Quality assessment of the included studies was performed using the MINORS scale. We included 20 retrospective observational studies with a combined total of 5139 participants. The results demonstrated that there was no statistically significant difference in terms of intraoperative complications, postoperative complications, reintervention rate, occurrence of GERD symptoms, GERD HRQL, use of proton pump inhibitors, and esophagitis between POEM and LHM groups. Conversely, POEM was associated with higher clinical success and shorter operative time, length of stay, and postoperative pain. This meta-analysis concludes that both POEM and LHM, are effective and safe treatments for achalasia. However, POEM demonstrates better results regarding clinical success, operative time, length of stay, postoperative pain, and a tendency towards lower recurrence.
贲门失弛缓症有多种治疗选择。然而，经口内镜肌切开术（POEM）和腹腔镜 Heller 肌切开术加胃底折叠术（LHM）以其疗效和低并发症发生率而著称。比较 POEM 和 LHM 在贲门失弛缓症患者中的几种结局。本系统评价按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。使用 PubMed、Web of Science 和 Cochrane Library 数据库进行了全面的文献检索。纳入了比较 POEM 和 LHM 在贲门失弛缓症患者中几种结局的研究。提取了临床成功率、手术时间、术中并发症、住院时间、再干预率、术后疼痛、总体并发症、GERD 症状发生、质子泵抑制剂使用和食管炎的数据。使用 MINORS 量表对纳入研究进行质量评估。我们纳入了 20 项回顾性观察研究，共有 5139 名参与者。结果表明，POEM 和 LHM 组在术中并发症、术后并发症、再干预率、GERD 症状发生、GERD HRQL、质子泵抑制剂使用和食管炎发生率方面无统计学差异。相反，POEM 与更高的临床成功率以及更短的手术时间、住院时间和术后疼痛相关。这项荟萃分析得出结论，POEM 和 LHM 都是治疗贲门失弛缓症的有效且安全的方法。然而，POEM 在临床成功率、手术时间、住院时间、术后疼痛方面表现更好，且复发率较低。
