Efficacy and safety of laparoscopic Heller myotomy versus peroral endoscopic myotomy on esophageal achalasia: A meta-analysis

doi:10.3969/j.issn.1004-583X.2024.08.002

Abstract

Abstract:

Objective To systematically evaluate the efficacy and safety of laparoscopic Heller myotomy (LHM) versus peroral endoscopic myotomy (POEM) on esophageal achalasia. Methods Relevant articles reporting the efficacy and safety of LHM versus POEM on esophageal achalasia published up to November 2023 were searched in the PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP and China Knowledge Network database (CNKI). Meta-analysis was performed using RevMan 5.0 software. Results A total of 15 articles were included, including 1 randomized controlled trial, 8 retrospective cohort studies, and 6 prospective non-randomized controlled trials. A total of 1, 439 patients were included, with 696 patients in the LHM group and 743 in the POEM group. Meta-analysis showed that POEM resulted in a significantly lower recurrent rate of postoperative dysphagia (OR=2.01, 95%CI 1.17, 3.44, P=0.01), shorter operative time (MD=22.66, 95%CI 5.57, 39.75, P=0.009), shorter length of stay (MD=0.55, 95%CI 0.38, 0.71, P<0.01), fewer days to return to normal life after surgery (MD=4.49, 95%CI 4.00, 4.97, P<0.01) than those in the LHM group, LHM resulted in a significantly lower incidences of gastroesophageal reflux disease (OR=0.64, 95%CI 0.45, 0.90, P=0.009) and postoperative subcutaneous emphysema (OR=0.33, 95%CI 0.11, 0.99, P=0.05) than those in the POEM group. The incidence of total postoperative complications, postoperative proton pump inhibitors utilization, and postoperative Eckardt score at 6 months were comparable between groups (P>0.05). Conclusion Compared with LHM, POEM has more advantages in lowering the recurrence of postoperative dysphagia, operative time, length of stay, and duration to return to normal life after surgery.

Key words: achalasia, laparoscopic Heller myotomy, peroral endoscopic myotomy, meta-analysis

CLC Number:

R571

Ye Zhibo, Li Keyong, Que Changhao, Wang Yaping, Gou Yunjiu. Efficacy and safety of laparoscopic Heller myotomy versus peroral endoscopic myotomy on esophageal achalasia: A meta-analysis[J]. Clinical Focus, 2024, 39(8): 684-692.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.08.002

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I8/684

Figures/Tables 15

Fig.1 Literature screening process and results

Tab.1 Baseline information of included studies

纳入研究	研究方法	国家	BMI		手术方式		例数	年龄(岁)		男/女(例)
纳入研究	研究方法	国家	LHM组	POEM组	LHM组	POEM组	例数	LHM组	POEM组	LHM组	POEM组
蒋彬^[8]2019	R	中国	NA	NA	LHM	POEM	61	44.1±14.8	45.4±14.6	14/16	18/13
Hungness^[9] 2013	R	美国	25	27	LHM	POEM	73	49	38	29/26	13/5
Ujiki^[10] 2013	PNC	美国	26.5±1.3	25.3±1.1	LHM	POEM	39	60.2±4.7	64.1±4.8	12/9	13/5
Bhayani^[11] 2014	R	美国	NA	NA	LHM	POEM	101	57 56	31/33	19/18
Kumagai^[12] 2014	PNC	瑞典	22.9±3.6	23.3±3.7	LHM	POEM	83	45	45.5	19/22	27/15
Chan^[13] 2016	R	中国	NA	NA	LHM	POEM	56	38.4	48.2	11/12	12/21
Leeds^[14] 2017	PNC	美国	28.8±5.2	25.7±4.0	LHM	POEM	23	52.7±12.4	52.0±16.9	6/5	4/8
Peng^[15] 2017	R	中国	NA	NA	LHM	POEM	31	44.7±21.6	37.5±13.0	8/10	8/5
Werner^[16] 2019	RCT	美国	24.5±4.5	24.8±4.6	LHM	POEM	221	48.6±14.6	41.7±14.8	60/49	68/44
Wirsching^[17] 2019	PNC	美国	27	30	LHM	POEM	51	56.6	58	12/16	11/12
Ali^[18] 2020	R	巴西	NA	NA	LHM	POEM	40	44.2±13.2	44.9±14.6	14/6	12/8
Costantini^[19] 2020	PNC	意大利	22	23	LHM	POEM	280	48	47	73/67	70/70
Attaar^[20] 2021	R	美国	26.8±5.7	27.1±6.7	LHM	POEM	159	58.0±19.0	64.0±16.0	19/14	62/64
Podboy^[21] 2021	R	美国	NA	NA	LHM	POEM	98	58.0±2.4	59.2±2.4	10/33	22/33
Wong^[22] 2023	PNC	马来西亚	NA	NA	LHM	POEM	123	48.1±17.3	41.7±14.8	31/29	29/34

Fig.2 Forest plot of meta-analysis of the recurrent rate of postoperative dysphagia in the two groups

Tab.2 Incidence of postoperative complications between the LHM group and the POEM group

并发症	纳入研究数量	样本量(例)		$I 2$ (%)	$O R$ 值	分析模型	95% $C I$	$P$ 值
并发症	纳入研究数量	LHM组	POEM组	$I 2$ (%)	$O R$ 值	分析模型	95% $C I$	$P$ 值
总体并发症	12^{[8⇓-10,12⇓⇓⇓ -16,18⇓ -20,22]}	561	628	27	0.82	固定效应模型	(0.55, 1.23)	0.33
胃食管反流病	10^{[8,10⇓⇓ -13,15,17,19,21,22]}	387	407	48	0.64	固定效应模型	(0.45, 0.90)	<0.05
皮下气肿	5^{[8⇓-10,13,15]}	147	113	16	0.33	固定效应模型	(0.11, 0.99)	0.05
食管穿孔	7^{[9- 10,12,14,16,19,22]}	437	405	0	0.86	固定效应模型	(0.39, 1.90)	0.7
黏膜损伤	4^[8,14,17,22]	129	129	67	0.86	随机效应模型	(0.11, 6.61)	0.89

Tab.2 Incidence of postoperative complications between the LHM group and the POEM group

并发症	纳入研究数量	样本量(例)		$I 2$ (%)	$O R$ 值	分析模型	95% $C I$	$P$ 值
并发症	纳入研究数量	LHM组	POEM组	$I 2$ (%)	$O R$ 值	分析模型	95% $C I$	$P$ 值
总体并发症	12^{[8⇓-10,12⇓⇓⇓ -16,18⇓ -20,22]}	561	628	27	0.82	固定效应模型	(0.55, 1.23)	0.33
胃食管反流病	10^{[8,10⇓⇓ -13,15,17,19,21,22]}	387	407	48	0.64	固定效应模型	(0.45, 0.90)	<0.05
皮下气肿	5^{[8⇓-10,13,15]}	147	113	16	0.33	固定效应模型	(0.11, 0.99)	0.05
食管穿孔	7^{[9- 10,12,14,16,19,22]}	437	405	0	0.86	固定效应模型	(0.39, 1.90)	0.7
黏膜损伤	4^[8,14,17,22]	129	129	67	0.86	随机效应模型	(0.11, 6.61)	0.89

Fig.3 Forest plot of meta-analysis of postoperative complications in the two groups

Fig.4 Forest plot of meta-analysis of the incidence of postoperative gastroesophageal reflux disease in the two groups

Fig.5 Forest plot of meta-analysis of operative time in the two groups

Fig.6 Forest plot of meta-analysis of length of stay in the two groups

Fig.7 Forest plot of meta-analysis for length of stay in the Asian group

Fig.8 Forest plot of meta-analysis for length of stay in non-Asian group

Fig.9 Forest plot of meta-analysis of postoperative PPI utilization in the two groups

Fig.10 Forest plot of meta-analysis of Eckardt score at moth 6 in the two groups

Fig.11 Forest plot of meta-analysis of the days to return to normal life after surgery in the two groups

Fig.12 Funnel plot of operation time

Fig.13 Funnel plot of the incidence of gastroesophageal reflux disease after surgery

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