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

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 Lower esophageal sphincter pressure, operation time, outcome, length of hospitalization, Eckardt score

Ann Gastroenterol 2024; 37 (6): 655-664