Albunni Hashem, Beran Azizullah, Hadaki Nwal, DeWitt John M, Al-Haddad Mohammad
Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
Dig Dis Sci. 2025 Feb;70(2):685-695. doi: 10.1007/s10620-024-08825-8. Epub 2025 Jan 13.
Peroral endoscopic myotomy (POEM) has become the treatment of choice for achalasia. However, the impact of myotomy length on POEM outcomes remains unclear. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the outcomes of short versus standard-length myotomy in achalasia patients.
We conducted a comprehensive search in PubMed, Embase, and Web of Science databases to identify all RCTs that compared POEM using short myotomy with standard myotomy. The primary outcomes were clinical success and post-operative gastroesophageal reflux disease (GERD). The secondary outcomes were procedural time, length of hospital stay, and intraprocedural complications. Pooled odds ratio (OR) and mean difference (MD) with the corresponding 95% confidence intervals (CIs) were calculated.
Three RCTs with 365 achalasia patients treated with short (n = 179) or standard (n = 186) myotomy were included. Short and standard myotomies showed similar clinical success (OR 1.95, 95% CI 0.61-6.23, p = 0.26; I = 41%), reflux symptoms (OR 0.97, 95% CI 0.49-1.89, p = 0.92; I = 20%), pathologic acid exposure on pH monitoring (OR 0.70, 95% CI 0.33-1.50, p = 0.36; I = 58%), reflux esophagitis on upper endoscopy (OR 0.82, 95% CI 0.40-1.70, p = 0.59; I = 42%), intraprocedural complications (OR 1.22, 95% CI 0.53-2.79, p = 0.65; I = 0%), and length of hospital stay (MD - 0.01, 95% CI - 0.72 to 0.69, p = 0.97, I = 73%). Procedural time was shorter in short myotomy (MD - 16.11 min, 95% CI - 26.04 to - 6.19, p = 0.001; I = 84%).
POEM using short myotomy for achalasia is non-inferior to standard myotomy for efficacy, safety, and post-operative GERD but is associated with a shorter procedural time.
经口内镜下肌切开术（POEM）已成为贲门失弛缓症的首选治疗方法。然而，肌切开长度对POEM治疗效果的影响仍不明确。我们对比较贲门失弛缓症患者短肌切开术与标准长度肌切开术治疗效果的随机对照试验（RCT）进行了系统评价和荟萃分析。
我们在PubMed、Embase和Web of Science数据库中进行了全面检索，以确定所有比较采用短肌切开术与标准肌切开术的POEM的RCT。主要结局为临床成功率和术后胃食管反流病（GERD）。次要结局为手术时间、住院时间和术中并发症。计算合并比值比（OR）和平均差（MD）及其相应的95%置信区间（CI）。
纳入3项RCT，共365例接受短肌切开术（n = 179）或标准肌切开术（n = 186）治疗的贲门失弛缓症患者。短肌切开术和标准肌切开术在临床成功率（OR 1.95，95%CI 0.61 - 6.23，p = 0.26；I² = 41%）、反流症状（OR 0.97，95%CI 0.49 - 1.89，p = 0.92；I² = 20%）、pH监测下的病理性酸暴露（OR 0.70，95%CI 0.33 - 1.50，p = 0.3
