肌切开长度对贲门失弛缓症经口内镜下肌切开术（POEM）疗效的影响：一项随机试验的荟萃分析
Impact of myotomy length on per-oral endoscopic myotomy (POEM) outcomes for achalasia: a meta-analysis of randomized trials.
作者信息
Wu Yizhong, Grieme Alexander, Garza Manuel, Smith Eric R, Beran Azizullah, Bushe Bryce, Han Andrew, Qatomah Abdulrahman, Spadaccini Marco, Tringali Alberto, Kunovský Lumír, Al-Haddad Mohammad A, Aihara Hiroyuki, Ramai Daryl
机构信息
Department of Internal Medicine, Baylor Scott & White Medical Center - Round Rock, Round Rock, TX, USA.
Division of Gastroenterology, Baylor Scott & White Medical Center - Round Rock, Round Rock, TX, USA.
出版信息
Surg Endosc. 2025 Sep 2. doi: 10.1007/s00464-025-12155-9.
INTRODUCTION
Peroral endoscopic myotomy (POEM) has been established as a safe and effective intervention for Type I and II achalasia. Studies have shown that short POEM is non-inferior to long POEM, with some evidence of decreased incidence of gastroesophageal reflux disease (GERD). This meta-analysis aims to systematically review and analyze randomized controlled trials (RCTs) data comparing clinical and safety outcomes for long and short POEM procedures while further investigating differences in GERD and other long-term clinical outcomes.
METHODS
We conducted a comprehensive search in PubMed, Embase, Cochrane, and Web of Science from inception until October 2024 for RCTs comparing long and short POEM procedures for the treatment of achalasia. Our pooled data was analyzed for clinical and objective procedural success, procedural adverse events, GERD outcomes, procedure time, and hospitalization time. A random effects model was used, and the data was presented using pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI).
RESULTS
Five RCTs were included with 518 achalasia patients (253 in short group and 265 in long group). Baseline characteristics of enrolled patients were similar across studies. Short and long POEM had similar clinical success (OR 1.18, 95% CI: 0.45-3.06, p = 0.73, I 0%), procedural adverse events (OR 0.72, 95% CI: 0.33-1.54, p = 0.39, I 0%), hospitalization time (0.14 days, 95% CI: - 0.13 to 0.40, p = 0.31, I 0%). Short POEM had shorter procedure time (MD - 16.68 min, 95% CI: - 22.77 to - 10.59, p < 0.00001, I 75%). The groups had similar symptomatic GERD (OR 0.86, 95% CI: 0.52-1.44, p = 0.57, I 0%), however short POEM had significantly lower acid exposure time (OR 0.62, 95% CI: 0.38 to 0.99, p = 0.04, I 0%) and erosive esophagitis after sensitivity analysis (OR 0.52, 95% CI: 0.27 to 1.01, p = 0.05, I 0%).
CONCLUSION
Our study demonstrates that short POEM is clinically non-inferior to long POEM but has advantages in shorter procedure time and lower odds of objective evidence of gastroesophageal reflux disease.
引言
经口内镜下肌切开术（POEM）已被确立为治疗I型和II型贲门失弛缓症的一种安全有效的干预措施。研究表明，短程POEM不劣于长程POEM，并有一些证据表明胃食管反流病（GERD）的发病率有所降低。本荟萃分析旨在系统回顾和分析比较长程和短程POEM手术的临床和安全性结果的随机对照试验（RCT）数据，同时进一步研究GERD和其他长期临床结果的差异。
方法
我们在PubMed、Embase、Cochrane和Web of Science数据库中进行了全面检索，检索时间从建库至2024年10月，以查找比较长程和短程POEM手术治疗贲门失弛缓症的RCT。我们对汇总数据进行分析，以评估临床和客观手术成功率、手术不良事件、GERD结果、手术时间和住院时间。采用随机效应模型，并使用汇总比值比（OR）和平均差值（MD）以及95%置信区间（CI）来呈现数据。
结果
纳入了5项RCT，共518例贲门失弛缓症患者（短程组253例，长程组265例）。各研究中纳入患者的基线特征相似。短程和长程POEM的临床成功率相似（OR 1.18，95%CI：0.45 - 3.06，p = 0.73，I² 0%），手术不良事件发生率相似（OR 0.72，95%CI：0.33 - 1.54，p = 0.39，I² 0%），住院时间相似（0.14天，95%CI： - 0.13至0.40，p = 0.31，I² 0%）。短程POEM的手术时间更短（MD - 16.68分钟，95%CI： - 22.77至 - 10.59，p < 0.00001，I² 75%）。两组的症状性GERD发生率相似（OR 0.86，95%CI：0.52 - 1.44，p = 0.57，I² 0%），然而，经敏感性分析后，短程POEM的酸暴露时间显著更低（OR 0.62，95%CI：0.38至0.99，p = 0.04，I² 0%），糜烂性食管炎发生率也更低（OR 0.52，95%CI：0.27至1.01，p = 0.05，I² 0%）。
结论
我们的研究表明，短程POEM在临床上不劣于长程POEM，但在手术时间更短以及胃食管反流病客观证据发生率更低方面具有优势。
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