ENDOSCOPIC OR SURGICAL MYOTOMY FOR ACHALASIA: AN OBJECTIVE PERSPECTIVE, SYSTEMATIC REVIEW AND META-ANALYSIS

Aims With the advent of the Lyon consensus, a modern evaluation of reflux, we aim to evaluate the literature comparing POEM to Heller myotomy (HM) for the treatment of achalasia with objective measurements.

Methods We conducted a systematic review of comparative studies between POEM and HM. The outcomes evaluated referred to efficacy, perioperative metrics, safety and updated evaluation of postoperative GERD.

Results 32 studies comparing POEM and HM were included: 30 observational studies and 2 RCTs.

The success rate (Eckardt score≤3) is higher in POEM (RD 0.07; 95% CI, 0.04 to 0.11; p<0.0001).

The operative duration and the length of stay (LOS) at the hospital are both shorter in POEM (respectively, MD -34.33 minutes and -0.43 days; p<0.0001 and p=0.005).

The major adverse events were similar in POEM and HM throughout the Clavien Dindo II-V (RD 0.00; 95% CI, -0.02 to 0.02; p=0.86).

The GERD through the Lyon consensus assessment indicates slightly favouring of HM in early EGD within 6 months (RD 0.05; 95% CI, -0.04 to 0.15; p=0.28) reduces until similar prevalence of postoperative GERD in both approaches in more than 6 months evaluation (RD 0.00; 95% CI, -0.04 to 0.04; p=0.86).

Conclusions When compared to HM, POEM had higher success rate of treatment of dysphagia, with shorter operative duration and LOS. In addition, when GERD is evaluated through the Lyon consensus, there were a higher incidence of postoperative GERD in POEM without statistical significance. Nonetheless, the difference between the two methodologies tend to resemble with time.

Publication History

Article published online:
14 April 2022