Systematic Review and Bayesian Network Meta-Analysis Comparing Laparoscopic Heller Myotomy, Pneumatic Dilatation, and Peroral Endoscopic Myotomy for Esophageal Achalasia

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a
Alberto AiolfiLuigi Bonavina

Abstract

Background: Laparoscopic Heller myotomy (LHM), pneumatic dilatation (PD), and peroral endoscopic myotomy (POEM) are common treatments for esophageal achalasia. Literature evidence is restricted to pairwise analysis and PD versus POEM comparison is missing. The aim of this network meta-analysis (NMA) was to comprehensively compare outcomes within these three surgical approaches with those of esophageal achalasia. Materials and Methods: PubMed, EMBASE, and Web of Science databases were consulted. A systematic review and a fully Bayesian study level arm-based random effect NMA were performed. Results: Nineteen studies (14 observational and 5 randomized controlled trial) and 4407 patients were included. Overall, 50.4% underwent LHM, 42.8% PD, and 6.8% POEM. The postoperative dysphagia remission was statistically significantly improved in POEM compared with LHM and PD (risk ratio [RR] = 1.21; 95% credible intervals [CIs] = 1.04-1.47 and RR = 1.40; 95% CIs = 1.14-1.79, respectively). Postoperative gastroesophageal reflux disease (GERD) rate was higher in POEM than in LHM and PD (RR = 1.75; 95% CIs = 1.35-2.03 and RR = 1.36; 95% CIs = 1.18-1.68, respectively). Postoperative Eckardt score was significantly lower in POEM than in LH...Continue Reading

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Citations

Jan 3, 2021·Digestive Diseases and Sciences·Kamesh GuptaDavid Desilets
Nov 12, 2020·Clinical and Experimental Gastroenterology·Pravallika ChadalavadaMadhusudhan R Sanaka
Jul 11, 2020·Journal of Clinical Gastroenterology·Madhusudhan R SanakaSiva Raja
May 29, 2021·World Journal of Gastrointestinal Endoscopy·Alexander A SmirnovSergey V Lapin
Oct 16, 2021·Journal of Clinical Gastroenterology·Jennifer Liu-BurdowskiMichel Kahaleh

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Software Mentioned

Confidence in Network Meta - Analysis ( CINeMA )
POEM

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