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Comparative efficacy of per-oral endoscopic myotomy and Heller myotomy in patients with achalasia: a meta-analysis

Title
Comparative efficacy of per-oral endoscopic myotomy and Heller myotomy in patients with achalasia: a meta-analysis
Authors
Park, Chan HyukJung, Da HyunKim, Do HoonLim, Chul-HyunMoon, Hee SeokPark, Jung HoJung, Hye-KyungHong, Su JinChoi, Suck CheiLee, Oh YoungKorean Soc Neurogastroenterology
Ewha Authors
정혜경
SCOPUS Author ID
정혜경scopus
Issue Date
2019
Journal Title
GASTROINTESTINAL ENDOSCOPY
ISSN
0016-5107JCR Link

1097-6779JCR Link
Citation
GASTROINTESTINAL ENDOSCOPY vol. 90, no. 4, pp. 546 - +
Publisher
MOSBY-ELSEVIER
Indexed
SCIE; SCOPUS WOS scopus
Document Type
Review
Abstract
Background and Aims: Although both per-oral endoscopic myotomy (POEM) and Heller myotomy (HM) have been used for the treatment of achalasia, the comparative efficacy of POEM and HM has yet to be fully evaluated. Methods: We searched all relevant studies published up to September 2018 examining the comparative efficacy between POEM and HM. Study quality was assessed using the Newcastle-Ottawa scale. Meta-analyses for Eckardt scores, perioperative outcomes, and reflux-related outcomes were performed based on a random-effects model. Results: Fifteen studies with a total of 1213 patients were evaluated. The follow-up duration ranged from 2 to 46.2 months and from 2 to 54.2 months in the POEM and HM groups, respectively. Postoperative Eckardt scores were lower (better) in the POEM group than in the HM group (pooled standardized mean difference [SMD], - 0.58; 95% confidence interval [CI], - 1.03 to - 0.13). Length of myotomy was greater in the POEM group than in the HM group (pooled SMD, 0.63; 95% CI, 0.42-0.84). There was no difference in reflux symptoms and pathologic reflux on pH monitoring between the groups (pooled risk ratio [RR], 1.03; 95% CI, 0.61-1.73; and pooled RR, 1.22; 95% CI, 0.67-2.25, respectively). Erosive esophagitis on endoscopy tended to be less common in the HM group (pooled RR, 1.88; 95% CI, 0.98-3.62). Conclusion: Although long-term follow-up data are insufficient, the short-term efficacy of POEM was superior to that of HM. Erosive esophagitis tended to be more common in the POEM group; however, there was no difference in reflux symptoms and pathologic reflux on pH monitoring between the groups.
DOI
10.1016/j.gie.2019.05.046
Appears in Collections:
의과대학 > 의학과 > Journal papers
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