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

Authors
 Chan Hyuk Park  ;  Da Hyun Jung  ;  Do Hoon Kim  ;  Chul-Hyun Lim  ;  Hee Seok Moon  ;  Jung Ho Park  ;  Hye-Kyung Jung  ;  Su Jin Hong  ;  Suck Chei Choi  ;  Oh Young Lee 
Citation
 GASTROINTESTINAL ENDOSCOPY, Vol.90(4) : 546-558.e3, 2019 
Journal Title
 GASTROINTESTINAL ENDOSCOPY 
ISSN
 0016-5107 
Issue Date
2019
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.
Full Text
https://www.sciencedirect.com/science/article/pii/S0016510719319388
DOI
10.1016/j.gie.2019.05.046
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Jung, Da Hyun(정다현)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175215
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