Gastroesophageal reflux disease over time in endoscopic versus surgical myotomy for treatment of achalasia: Systematic review and meta-analysis.

IF 2.3 Q3 GASTROENTEROLOGY & HEPATOLOGY
Endoscopy International Open Pub Date : 2025-06-17 eCollection Date: 2025-01-01 DOI:10.1055/a-2621-5421
Angelo So Taa Kum, Beanie Conceição Medeiros Nunes, Eduardo Turiani Hourneaux Moura, Matheus Cavalcante Franco, Eduardo Guimarães Hourneaux de Moura
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Abstract

Background and study aims: Achalasia, a motor disorder of the esophagus, is treated with peroral endoscopic myotomy (POEM) or Heller myotomy with fundoplication (HMF). Although POEM lacks an antireflux mechanism, potentially increasing postoperative gastroesophageal reflux disease (GERD), limiting the endoscopic approach, this difference in GERD tends to diminish over time. The objective of this study was to compare GERD over time, the need for regular gastric acid suppression therapy (GAST), effectiveness, and safety between POEM and HMF in treating achalasia.

Methods: A systematic review and meta-analysis was conducted by searching mainly in MEDLINE, EMBASE, and ClinicalTrials.gov. Primary outcomes included early (< 12 months) and late (≥ 12 months) evaluations of postoperative GERD based on endoscopic criteria of the Lyon Consensus 2.0, and GAST. Secondary outcomes included clinical success (Eckardt score ≤ 3), procedure time, length of stay, and major adverse events (AEs) (Clavien-Dindo classification ≥ 2).

Results: Thirty-two observational studies and two randomized trials were included, totaling 14,125 patients. GERD was higher in POEM in early evaluation (risk ratio [RR] = 3.03; P P < 0.01). GERD occurrence was similar between POEM and HMF in the late evaluation ( P = 0.30). Higher GAST was observed in POEM (RR = 1.35; P = 0.02). Secondly, clinical success was higher in POEM (RR = 1.06; P = 0.01), with shorter procedure time (median 39.53 minutes; P < 0.01) and shorter length of stay (mean different = -0.51 day; P = 0.03), with similar major AEs ( P = 0.81) compared with HMF.

Conclusions: A higher rate of early GERD is observed in POEM compared with HMF, with the difference waning over time and reaching equivalence after 12 months, despite a higher rate of GAST in the endoscopic group. POEM also exhibited effectiveness and safety comparable to the surgical approach.

胃食管反流疾病随时间的内镜与手术肌切开术治疗贲门失弛缓症:系统回顾和荟萃分析。
背景和研究目的:贲门失弛缓症是一种食道运动障碍,治疗方法为经口内窥镜肌切开术(POEM)或Heller肌切开术合并底襞(HMF)。尽管POEM缺乏抗反流机制,可能增加术后胃食管反流病(GERD),限制了内镜入路,但这种差异随着时间的推移趋于减弱。本研究的目的是比较POEM和HMF治疗贲门失弛缓症的时间差异、常规胃酸抑制治疗(GAST)的必要性、有效性和安全性。方法:通过检索MEDLINE、EMBASE和ClinicalTrials.gov进行系统综述和荟萃分析。主要结果包括早期(< 12个月)和晚期(≥12个月)基于内镜下里昂共识2.0和GAST标准的术后GERD评估。次要结局包括临床成功(Eckardt评分≤3)、手术时间、住院时间和主要不良事件(ae) (Clavien-Dindo分级≥2)。结果:纳入32项观察性研究和2项随机试验,共计14125例患者。早期评价时,POEM患者的GERD较高(风险比[RR] = 3.03;P < 0.01)。在后期评价中,POEM和HMF组的胃食管反流发生率相似(P = 0.30)。POEM患者GAST升高(RR = 1.35;P = 0.02)。其次,POEM患者的临床成功率较高(RR = 1.06;P = 0.01),手术时间较短(中位39.53分钟;P < 0.01),住院时间较短(平均差= -0.51天;P = 0.03),主要ae与HMF相似(P = 0.81)。结论:与HMF组相比,POEM组的早期GERD发生率更高,随着时间的推移,差异逐渐减小,12个月后达到相等,尽管内镜组的GAST发生率更高。POEM也显示出与手术入路相当的有效性和安全性。
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来源期刊
Endoscopy International Open
Endoscopy International Open GASTROENTEROLOGY & HEPATOLOGY-
自引率
3.80%
发文量
270
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