Evidence map›Paper›PMID 40624423›Full record

SynthesisSurgical endoscopy2025

Long-term outcomes after per-oral endoscopic myotomy versus laparoscopic Heller myotomy in the treatment of achalasia: a systematic review and meta-analysis.

Odelle Ma, Karanbir Brar, Sydney McCluskey, Dunavan Morris-Janzen, Jeremy Peabody, Simon Turner

Abstract readSystematic ReviewMeta-AnalysisComparative Study
PubMed Publisher
In one paragraph

Synthesis in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Odelle Ma *Division of General Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada. odelle@ualberta.ca.ORCID http://orcid.org/0000-0002-0401-9249
Karanbir Brar *Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Sydney McCluskeyFaculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Dunavan Morris-JanzenDivision of General Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Jeremy PeabodyDivision of General Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Simon TurnerDivision of Thoracic Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAchalasia is a rare, benign esophageal motility disorder. Laparoscopic Heller myotomy (LHM) is the gold standard treatment. Per-oral endoscopic myotomy (POEM) is an alternative endoscopic technique that has comparable short-term results to LHM. There are limited data on long-term results. We performed a systematic review and meta-analysis to evaluate longer-term outcomes in POEM compared to LHM for the treatment of achalasia.

methodsWe searched EMBASE, Pubmed, Medline and CENTRAL databases through January 2024. We included primary double-arm studies in adult patients with follow-up periods of ≥ 24 months. The primary outcome was treatment success, defined as Eckardt score ≤ 3. Secondary outcomes were operation length, length of stay, postoperative complications and postoperative gastroesophageal reflux disease (GERD). Two authors independently reviewed studies, extracted data, and assessed quality of evidence using the Cochrane Risk-of-Bias tool for Randomized Trials Version 2 and the Risk of Bias in Nonrandomized Studies-of Intervention tool. Pooled estimates were calculated using random effects meta-analyses. Heterogeneity was quantified using the inconsistency statistic, and funnel plot was used to assess publication bias.

resultsThere were 9 studies included with 1099 patients; 583 underwent POEM with a mean follow-up length of 34.2 months. There was no difference in treatment success between POEM and LHM (OR 1.43; CI 0.96-2.13). POEM had a significantly shorter operative time (MD -35.69 min; CI -50.54-[- 20.83]), shorter length of stay (MD - 0.70 days; CI -1.03-[- 0.36]) and comparable incidence of complications (OR 0.80; CI 0.37-1.73). Meta-analysis showed a significantly increased risk of esophagitis with POEM when outlier studies were excluded (OR 2.57; CI 1.45-4.53]), though there was a greater odds of continued postoperative PPI use in POEM (OR 1.72; CI 1.03-2.89]).

conclusionPOEM appears to have equivalent long-term efficacy to LHM, with possibly higher risk of postoperative GERD. More randomized studies are needed to examine outcomes beyond 2 years and to determine the long-term clinical significance of GERD following POEM.

Indexed as

Esophageal AchalasiaHeller MyotomyLaparoscopyNatural Orifice Endoscopic SurgeryHumansLength of StayOperative TimePostoperative ComplicationsTreatment OutcomeAchalasiaDysphagiaHeller myotomyMeta-analysisPOEMSystematic review

Identifiers

PMID40624423

What OpenQuestion holds

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Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.