title: Surgery or Peroral Esophageal Myotomy for Achalasia: A Systematic Review and Meta-Analysis.
abstract: To date very few studies with small sample size have compared peroral esophageal myotomy (POEM) with the current surgical standard of care, laparoscopic Heller myotomy (LHM), in terms of efficacy and safety, and no recommendations have been proposed.To investigate the efficacy and safety of POEM compared with LHM, for the treatment of achalasia.The databases of Pubmed, Medline, Cochrane, and Ovid were systematically searched between January 1, 2005 and January 31, 2015, with the medical subject headings (MeSH) and keywords "achalasia," "POEM," "per oral endoscopic myotomy," and "peroral endoscopic myotomy," "laparoscopic Heller myotomy" (LHM), "Heller myotomy."All types of study designs including adult patients with diagnosis of achalasia were selected. Studies that did not report the comparison between endoscopic and surgical treatment, experimental studies in animal models, single case reports, technical reports, reviews, abstracts, and editorials were excluded.The total number of included patients was 486 (196 in POEM group and 290 in LHM group).There were no differences between POEM and LHM in reduction in Eckardt score (MD = -0.659, 95% CI: -1.70 to 0.38, P = 0.217), operative time (MD = -0.354, 95% CI: -1.12 to 0.41, P = 0.36), postoperative pain scores (MD = -1.86, 95% CI: -5.17 to 1.44, P = 0.268), analgesic requirements (MD = -0.74, 95% CI: -2.65 to 1.16, P = 0.445), and complications (OR = 1.11, 95% CI: 0.5-2.44, P = 0.796). Length of hospital stay was significantly lower for POEM (MD = -0.629, 95% CI: -1.256 to -0.002, P = 0.049). There was a trend toward significant reduction in symptomatic gastroesophageal reflux rate in favors of LHM compared to POEM group (OR = 1.81, 95% CI: 1.11-2.95, P = 0.017).All included studied were not randomized. Furthermore all selected studies did not report the results of follow-up longer than 1 year and most of them included patients who were both treatment naive and underwent previous endoscopic or surgical interventions for achalasia.POEM represents a safe and efficacy procedure comparable to the safety profile of LHM for achalasia at a short-term follow-up. Long-term clinical trials are urgently needed.
authors.affiliation: From the General, Minimally Invasive and Robotic Surgery, Department of Surgery, "San Matteo degli Infermi Hospital"-ASL Umbria 2, Spoleto (PG), Italy (LM, AS, AP), Esophageal Surgery Unit, Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease, Cisanello Hospital, Pisa, Italy (GP, BS, SS), Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine, Orange, CA (AP), Department of Surgical Oncology, National Cancer Research Centre-Istituto Tumori "G. Paolo II", Bari, Italy (RDL), Department of Abdominal and Thoracic Minimally Invasive Surgery, "San Giuseppe Moscati" Hospital, Avellino, Italy (FGB), Department of Surgery, "San Giovanni Battista Hospital"-ASL Umbria 2, Foligno (PG), Italy (ML), Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine, Second University of Naples, Naples, Italy (NDM), and Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy (VB).
authors.forename: Luigi
authors.initials: L
authors.lastname: Marano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pallabazzer
authors.forename: Biagio
authors.initials: B
authors.lastname: Solito
authors.forename: Stefano
authors.initials: S
authors.lastname: Santi
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Luca
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: Biondo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Spaziani
authors.forename: Maurizio
authors.initials: M
authors.lastname: Longaroni
authors.forename: Natale
authors.initials: N
authors.lastname: Di Martino
authors.forename: Virginia
authors.initials: V
authors.lastname: Boccardi
authors.forename: Alberto
authors.initials: A
authors.lastname: Patriti
mesh_terms: D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D009055:Mouth; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D016896:Treatment Outcome