评估经口内镜下肌切开术治疗贲门失弛缓症的肌切开长度：一项对随机对照试验的分级评估荟萃分析。

Evaluating Myotomy Length in POEM for Achalasia: A Grade-Assessed Meta-Analysis of Randomized Controlled Trials.

作者信息

Rajab Islam, Abu Suilik Husam, Awashra Ameer, Saleh Othman, Alhawi Moayad, Ashour Abdelrahman, Elgendy Mohamed S, Abu Suilik Mohamed, Alkomos Mina F, Cavanagh Yana, Hussein Abdallah

机构信息

Department of Internal Medicine, St Joseph University Medical Center, Paterson.

Faculty of Medicine, Hashemite University, Zarqa.

出版信息

J Clin Gastroenterol. 2025 Sep 1. doi: 10.1097/MCG.0000000000002243.

DOI:10.1097/MCG.0000000000002243

PMID:40892045

Abstract

BACKGROUND

Peroral endoscopic myotomy (POEM) is a standard achalasia treatment, matching surgery in efficacy. However, myotomy length varies. Shorter myotomies are gaining attention for potential benefits. This study compares short versus long myotomies to identify the optimal approach.

METHODS

We conducted a systematic review and meta-analysis of Randomized Controlled Trials (RCTs) retrieved from PubMed (MEDLINE), Scopus, Web of Science (WoS), and Cochrane Central Register of Controlled Trials (CENTRAL) until November 28, 2024. Pooled results were calculated using risk ratios (RR) for binary outcomes and mean differences (MD) for continuous outcomes, with 95% CI (PROSPERO ID: CRD42024621638).

RESULTS

Four RCTs with 419 patients were included. Clinical success (Eckardt score ≤3) showed no significant difference between short and long myotomy (97.4% vs. 95.9%, RR: 1.02 with 95% CI: 0.98-1.06, P=0.33), Reflux symptoms (RR: 0.93, 95% CI: 0.60-1.47, P=0.77), and reflux esophagitis (RR: 0.83, 95% CI: 0.55-1.27, P=0.39). However, short myotomy significantly reduced pathologic acid exposure (RR: 0.57, 95% CI: 0.36-0.91, P=0.02), procedural time (MD: -16.61 min, 95% CI: -26.40 to -6.81, P<0.001), and hospital stay (MD: -2.37 d, 95% CI: -4.67 to -0.06, P=0.04). Intraprocedural complications were similar (P=0.73), as was integrated relaxation pressure (P=0.95), indicating similar postoperative esophageal function.

CONCLUSION

Short myotomy reduced acid exposure, procedure time, and hospital stay in POEM for achalasia without compromising clinical success or symptom improvement. It shows potential as an effective treatment, but large-scale RCTs are needed for definitive clinical endorsement.

摘要

背景

经口内镜下肌切开术（POEM）是贲门失弛缓症的标准治疗方法，疗效与手术相当。然而，肌切开术的长度各不相同。较短的肌切开术因其潜在益处而受到关注。本研究比较短肌切开术和长肌切开术，以确定最佳方法。

方法

我们对截至2024年11月28日从PubMed（MEDLINE）、Scopus、科学网（WoS）和Cochrane对照试验中央注册库（CENTRAL）检索到的随机对照试验（RCT）进行了系统评价和荟萃分析。使用二元结局的风险比（RR）和连续结局的平均差（MD）计算合并结果，并给出95%置信区间（PROSPERO注册号：CRD42024621638）。

结果

纳入了4项RCT，共419例患者。临床成功率（ Eckardt评分≤3）在短肌切开术和长肌切开术之间无显著差异（97.4%对95.9%，RR：1.02，95%CI：0.98-1.06，P=0.33），反流症状（RR：0.93，95%CI：0.60-1.47，P=0.77）和反流性食管炎（RR：0.83，95%CI：0.55-1.27，P=0.39）。然而，短肌切开术显著降低了病理性酸暴露（RR：0.57，95%CI：0.36-至0.91，P=0.02）、手术时间（MD：-16.61分钟，95%CI：-26.40至-6.81，P<0.001）和住院时间（MD：-2.37天，95%CI：-4.67至-0.06，P=0.04）。术中并发症相似（P=0.73），综合松弛压力也相似（P=0.95），表明术后食管功能相似。