Per-Oral Endoscopic Myotomy versus Heller Myotomy in Patients with Achalasia: Meta-analysis Study

Abstract Background Achalasia is a primary esophageal motility disorder of unknown etiology characterized manometrically by insufficient relaxation of the lower esophageal sphincter (LES) and loss of esophageal peristalsis in the absence of mechanical obstruction, radiographically by esophageal dilation with minimal LES opening ―bird-beak appearance, poor emptying of barium; and endoscopically by dilated esophagus with retained saliva, liquid, and undigested food particles in the absence of mucosal structuring or tumor Objective To compare the efficacy of per-oral endoscopic myotomy and heller myotomy in achalastic patients Patients and Methods We searched for all relevant studies published between January 2000 and September 2018 that examined the post- operative Eckardt score, perioperative outcomes, and acid reflux-related adverse events between POEM and HM, using MEDLINE, EMBASE, and the Cochrane Library data- bases. The following search string was used: ((POEM) or (endoscopic myotomy)) and ((laparoscopic myotomy) or (surgical myotomy) or (Heller myotomy) or (Heller’s myotomy)). The detailed search strategies in each database are shown in (available online at www.giejournal. org). In addition, we examined the references of the screened articles to identify additional studies. The date of our most recent search update was September 18, 2018. Results Our meta-analysis provides a better understanding of the comparative efficacy of POEM and HM in patients with achalasia. Although long-term follow-up data in this regard are currently insufficient and considerable heterogeneity was identified in the meta- analysis, the short-term efficacy of POEM was superior to that of HM. The length of myotomy was also greater in POEM than in HM. The operation time and length of hospital stay tended to be shorter in POEM than in HM, however the difference was not big between both. Erosive esophagitis tended to be more common in POEM as fundoplication cannot be done with it. 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.