Comparison of the safety, efficacy, and rates of GERD between full-thickness versus modified peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis.

BACKGROUND AND AIMS

Studies have shown variable results when comparing full-thickness (FT) peroral endoscopic myotomy (POEM) with modified myotomy (MM) techniques (such as selective circular myotomy [CM] and oblique fiber-sparing myotomy [OS]). We performed a meta-analysis to reconcile the data.

METHODS

Online databases were searched for studies comparing FT to MM POEM for treatment of achalasia. The outcomes of interest were procedure duration (min), clinical success (Eckardt score ≤3), symptomatic reflux, reflux esophagitis, mean Eckardt score, lower esophageal sphincter pressure, and adverse events. Pooled odds ratios (OR) and standardized mean difference (SMD) along with 95% CIs were calculated.

RESULTS

A total of 9 studies (1226 patients) were included, with 540 in the FT and 686 in the MM groups. Compared with the MM group, the FT group exhibited a higher rate of symptomatic reflux (OR, 1.58; 95% CI, 1.12-2.23, P = .009), with the other outcomes being comparable in the 2 groups. Subgroup analysis revealed that OS was associated with reduced symptomatic reflux compared with FT. While the FT and CM groups had similar rates of symptomatic reflux, the former had shorter procedure duration.

CONCLUSIONS

Our analysis showed that MM POEM (the OS technique) may lead to reduced symptomatic reflux compared with FT POEM for achalasia. The limited number of included studies (with most of them being observational) must be considered while interpreting these findings.