Minimally Invasive Surgery For Achalasia Regarding The Efficacy And Safety:A Systematic Review

Objective:a systematic review of comparing POEM(peroral esophageal myotomy)with LHM(laparoscopic Heller's myotomy)for achalasia about the clinical effect and safety.Methods:The datebases including PubMed,Embase,the Cochrane Library,Web of Science,CNKI and China Science and Technology Journal Datebase were fully searched for relevant articles published in Chinese and English form datebase inception to 20 February 2016.The date were analyzed using Review Manager version 5.3 software.To assess the variation across studies,heterogeneity was measured with the I~2 index and Q test.Results:Eight non-randomized comparative studies that included a total of 574 patients(245 in the POEM group and 329 in the LHM group)met our research criteria and were assessed.Meta-analysis results were showed as follows:(1)the clinical effect:POEM group had a better result than LHM group[RR=1.14,95%CI(1.02,1.27),P=0.02]with high between-studyhomogeneity(P=0.60,I~2=0%);(2)major complications:There was no difference between POEM group and LHM group[RR=1.16,95%CI(0.76,1.78),P=0.49]with high between-study homogeneity(P=0.43,I~2=0%);(3)all complications:No significant difference was detected between POEM group and LHM group[RR=0.99,95%CI(0.72,1.36),P=0.94].Moderateheterogeneity existed among the inchuded studies(P=0.12,I~2=39%);(4)length of hospital stay:There was no statistically different between two groups[MD=-0.46,95%CI(-1.09,0.16),P=0.14]with high between-study heterogeneity(P=0.0007,I~2=76%);(5)operation time:The outcome showed no significant difference between POEM group and LHM group[MD=-35.45 95%CI(-87.01,16.10),P=0.18]with high heterogeneity(P<0.00001,I~2=98%).Conclusions:we identified that POEM is high-efficiency and safe.Meanwhile it may be a promising treatment for achalasia.POEM is superior to LHM in terms of short-time clinical effectivity,intraoperative blood loss and postoperative analgesic requirment.however no statistically diffetent between them was detected in the aspect of complications,length of hospital stay and operation time.It isn't confirmed whether POEM is the best therapy for achalasia or not.More high quality,multicenter and large sample RCTs and long-time follow-up studies are needed to verify it in the future.