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. 2024 Nov-Dec;37(6):655-664.
doi: 10.20524/aog.2024.0923. Epub 2024 Oct 23.

Laparoscopic Heller myotomy versus peroral endoscopic myotomy in children with esophageal achalasia: a systematic review and meta-analysis

Anastasia Dimopoulou  1 , Dimitra Dimopoulou  2 , Antonis Analitis  3 , Konstantina Dimopoulou  4 , Dionysios Dellaportas  5 , Nikolaos Zavras  6
Affiliations

Laparoscopic Heller myotomy versus peroral endoscopic myotomy in children with esophageal achalasia: a systematic review and meta-analysis

Anastasia Dimopoulou et al. Ann Gastroenterol. 2024 Nov-Dec.

Abstract

Background: Currently, laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM) are the best treatment modalities for esophageal achalasia in children. The purpose of this systematic review and meta-analysis is to compare the efficacy of LHM and POEM.

Methods: A systematic literature search was performed in PubMed/Medline, Google Scholar and Web of Science for original articles comparing LHM and POEM. All articles were analyzed with respect to operation duration, length of hospital stay, pre- and postoperative Eckardt score (ES), and pre- and postoperative lower esophageal sphincter (LES) pressure.

Results: A total of 32 articles, reporting on 800 children, were selected and reviewed. Because of missing diagnostic values of ES and LES in the LHM group, the meta-analysis was limited to the POEM results. According to the random-effects model, the mean ES difference between pre- and post-operation was 4.387 (95% confidence interval [CI] 3.799-4.974), significantly different to zero (z=14.64, P<0.001), while the mean LES pressure difference was 3.63 mmHg mmHg (95%CI 2247-3.879), significantly different to zero (z=7.36, P<0.001). Operation duration was 130.15 min (95%CI 62.59-197.71) for the LHM method and 83.64 min (95%CI 55.14-112.14) for POEM. The pooled estimate of length of hospital stay was 3.4 days (95%CI 2.6-4.44) and it was comparable between the 2 methods.

Conclusions: POEM has positive outcomes regarding ES and LES pressure pre- and postoperatively, as well as operation duration, while the length of hospitalization was comparable between POEM and LHM. Well-designed studies are warranted to further clarify differences between the 2 methods.

Keywords: Eckardt score; Lower esophageal sphincter pressure; length of hospitalization; operation time; outcome.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Flow chart showing the design of the systematic review
Figure 2
Figure 2
Forrest plot of mean Eckardt score difference, preoperatively and postoperatively, for the peroral endoscopic myotomy (POEM) procedure SMD, standardized mean difference; CI, confidence interval
Figure 3
Figure 3
Forrest plot of mean lower esophageal sphincter (LES) pressure difference preoperatively and postoperatively for the peroral endoscopic myotomy (POEM) procedure SMD, standardized mean difference; CI, confidence interval
Figure 4
Figure 4
Forest plot of random-effects meta-analysis of the operation time (min) over all studies and by method of operation: laparoscopic Heller myotomy (LHM) vs. peroral endoscopic myotomy (POEM) ES, Eckardt score; CI, confidence interval
Figure 5
Figure 5
Forest plot of random-effects meta-analysis of the length of hospital stay (days) over all studies and by method of operation: laparoscopic Heller myotomy (LHM) vs. peroral endoscopic myotomy (POEM) ES, Eckardt score; CI, confidence interval
See this image and copyright information in PMC

References

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