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Abstract：
BACKGROUND: Peroral endoscopic myotomy (POEM) has been demonstrated to be safe and effective in the treatment of achalasia. Longer myotomy is the standard POEM procedure for achalasia but when compared with shorter myotomy, its effectiveness is not as well known.
OBJECTIVE: To compare the clinical effectiveness of longer and shorter myotomy.
METHODS: PubMed, EmBase, Cochrane Library, web of science and clinicaltrials.gov were queried for studies comparing shorter and longer POEM for achalasia treatment. The primary outcome was clinical success rate. Secondary outcomes comprised of operative time, adverse events (AEs) rate, gastroesophageal reflux disease (GERD) and procedure-related parameters. The Mantel-Haenszel fixed-effects model was primarily used for the analysis. Publication bias was assessed.
RESULTS: Six studies were included in this analysis with a total of 514 participants. During the follow-up period of 1-28.7 mo, longer and shorter myotomy in treating achalasia showed similar excellent effectiveness [overall clinical success (OR = 1, 95%CI: 0.46-2.17, P = 1, I2: 0%; subgroup of abstract (OR = 1.19, 95%CI: 0.38 to 3.73; P = 0.76; I2: 0%); subgroup of full text (OR = 0.86 95%CI: 0.30 to 2.49; P = 0.78; I2: 0%)]. Shorter myotomy had significantly reduced mean operative time compared with the longer procedure. There were no statistically significant differences in AEs rates, including GERD (overall OR = 1.21, 95%CI: 0.76-1.91; P = 0.42; I2: 9%; subgroup of abstract OR = 0.77, 95%CI: 0.40-1.47; P = 0.43; I2: 0%; subgroup of full text OR = 1.91, 95%CI: 0.98-3.75; P = 0.06; I2: 0%), hospital stay (overall MD = -0.07, 95%CI: -0.30 to 0.16; P = 0.55; I2: 24%; subgroup of abstract MD = 0.20, 95%CI: -0.25 to 0.65; P = 0.39; I2: 0; subgroup of full text MD = -0.16, 95%CI: -0.42 to 0.10; P = 0.23; I2: 42%), and major bleeding (overall OR = 1.25, 95%CI: 0.58-2.71; P = 0.56; I2: 0%) between the two procedures. These differences remained statistically non-significant in all sensitivity analyses.
CONCLUSIONS: POEM was effective in treating achalasia. Shorter and longer myotomy procedures provided similar therapeutic effects in terms of long-term effectiveness. In addition, shorter myotomy reduced the operative time.
OBJECTIVE: To compare the clinical effectiveness of longer and shorter myotomy.
METHODS: PubMed, EmBase, Cochrane Library, web of science and clinicaltrials.gov were queried for studies comparing shorter and longer POEM for achalasia treatment. The primary outcome was clinical success rate. Secondary outcomes comprised of operative time, adverse events (AEs) rate, gastroesophageal reflux disease (GERD) and procedure-related parameters. The Mantel-Haenszel fixed-effects model was primarily used for the analysis. Publication bias was assessed.
RESULTS: Six studies were included in this analysis with a total of 514 participants. During the follow-up period of 1-28.7 mo, longer and shorter myotomy in treating achalasia showed similar excellent effectiveness [overall clinical success (OR = 1, 95%CI: 0.46-2.17, P = 1, I2: 0%; subgroup of abstract (OR = 1.19, 95%CI: 0.38 to 3.73; P = 0.76; I2: 0%); subgroup of full text (OR = 0.86 95%CI: 0.30 to 2.49; P = 0.78; I2: 0%)]. Shorter myotomy had significantly reduced mean operative time compared with the longer procedure. There were no statistically significant differences in AEs rates, including GERD (overall OR = 1.21, 95%CI: 0.76-1.91; P = 0.42; I2: 9%; subgroup of abstract OR = 0.77, 95%CI: 0.40-1.47; P = 0.43; I2: 0%; subgroup of full text OR = 1.91, 95%CI: 0.98-3.75; P = 0.06; I2: 0%), hospital stay (overall MD = -0.07, 95%CI: -0.30 to 0.16; P = 0.55; I2: 24%; subgroup of abstract MD = 0.20, 95%CI: -0.25 to 0.65; P = 0.39; I2: 0; subgroup of full text MD = -0.16, 95%CI: -0.42 to 0.10; P = 0.23; I2: 42%), and major bleeding (overall OR = 1.25, 95%CI: 0.58-2.71; P = 0.56; I2: 0%) between the two procedures. These differences remained statistically non-significant in all sensitivity analyses.
CONCLUSIONS: POEM was effective in treating achalasia. Shorter and longer myotomy procedures provided similar therapeutic effects in terms of long-term effectiveness. In addition, shorter myotomy reduced the operative time.
摘要：
背景：经口内镜下肌切开术（POEM）已被证明在治疗贲门失弛缓症方面是安全有效的。较长肌切开术是贲门失弛缓症的标准POEM手术，但与较短肌切开术相比，其有效性并不为人所知。
目的：比较长和短肌切开术的临床疗效。
方法：PubMed，Embase,科克伦图书馆,查询了科学和临床试验网。gov，以比较较短和较长的POEM治疗贲门失弛缓症的研究。主要结果是临床成功率。次要结果包括手术时间，不良事件（AE）率，胃食管反流病（GERD）和手术相关参数。Mantel-Haenszel固定效应模型主要用于分析。评估了发表偏倚。
结果：这项分析纳入了6项研究，共有514名参与者。在1-28.7个月的随访期间，较长和较短的肌切开术治疗门失弛缓症的疗效相似[总体临床成功率（OR=1，95CI：0.46-2.17，P=1，I2：0％；摘要亚组（OR=1.19，95CI：0.38至3.73；P=0.76；I2：0％）；全文亚组（OR=0.8695CI：0.30至2.49；P=0.78；I2：0％与较长的手术相比，较短的肌切开术显着减少了平均手术时间。不良事件发生率差异无统计学意义，包括GERD(总体OR=1.21,95CI:0.76-1.91;P=0.42;I2:9%;抽象OR=0.77,95CI:0.40-1.47;P=0.43;I2:0%;全文OR=1.91,95CI:0.98-3.75;P=0.06;I2:0%),住院时间（总体MD=-0.07，95CI：-0.30至0.16；P=0.55；I2：24％；摘要MD亚组=0.20，95CI：-0.25至0.65；P=0.39；I2：0；全文MD亚组=-0.16，95CI：-0.42至0.10；P=0.23；I2：42％），和严重出血（总OR=1.25，95CI：0.58-2.71；P=0.56；I2：0%）。在所有敏感性分析中，这些差异在统计学上不显著。
结论：POEM治疗门失弛缓症有效。较短和较长的肌切开术在长期有效性方面提供了相似的治疗效果。此外,较短的肌切开术减少了手术时间。
目的：比较长和短肌切开术的临床疗效。
方法：PubMed，Embase,科克伦图书馆,查询了科学和临床试验网。gov，以比较较短和较长的POEM治疗贲门失弛缓症的研究。主要结果是临床成功率。次要结果包括手术时间，不良事件（AE）率，胃食管反流病（GERD）和手术相关参数。Mantel-Haenszel固定效应模型主要用于分析。评估了发表偏倚。
结果：这项分析纳入了6项研究，共有514名参与者。在1-28.7个月的随访期间，较长和较短的肌切开术治疗门失弛缓症的疗效相似[总体临床成功率（OR=1，95CI：0.46-2.17，P=1，I2：0％；摘要亚组（OR=1.19，95CI：0.38至3.73；P=0.76；I2：0％）；全文亚组（OR=0.8695CI：0.30至2.49；P=0.78；I2：0％与较长的手术相比，较短的肌切开术显着减少了平均手术时间。不良事件发生率差异无统计学意义，包括GERD(总体OR=1.21,95CI:0.76-1.91;P=0.42;I2:9%;抽象OR=0.77,95CI:0.40-1.47;P=0.43;I2:0%;全文OR=1.91,95CI:0.98-3.75;P=0.06;I2:0%),住院时间（总体MD=-0.07，95CI：-0.30至0.16；P=0.55；I2：24％；摘要MD亚组=0.20，95CI：-0.25至0.65；P=0.39；I2：0；全文MD亚组=-0.16，95CI：-0.42至0.10；P=0.23；I2：42％），和严重出血（总OR=1.25，95CI：0.58-2.71；P=0.56；I2：0%）。在所有敏感性分析中，这些差异在统计学上不显著。
结论：POEM治疗门失弛缓症有效。较短和较长的肌切开术在长期有效性方面提供了相似的治疗效果。此外,较短的肌切开术减少了手术时间。
