{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T13:17:21Z","timestamp":1770556641914,"version":"3.49.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T00:00:00Z","timestamp":1628121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,11]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Introduction: Achalasia may evolve to sigmoid megaesophagus in 10\u201315% of patients and is usually treated with esophagectomy, which has high morbi-mortality. Many surgeons debate the applicability of the Heller myotomy for treating sigmoid megaesophagus. This study intents to analyze the effectiveness of myotomy for treating patients with sigmoid megaesophagus. Methods: A systematic review and meta-analysis was conducted in PubMed, Cochrane, Lilacs and Embase alongside manual search of references. The inclusion criteria were clinical trials, cohort, case-series; patients with sigmoid megaesophagus and esophageal diameter\u2009\u2265\u20096\u00a0cm; and patients undergoing primary myotomy. The exclusion criteria were reviews, case reports, cross-sectional studies, editorials, letters, congress abstracts, full-text unavailability; previous surgical treatment for achalasia; and pediatric or animal model studies. No restrictions on language and date of publication, and no filters were applied. Subgroups analyses were performed to assess the laparoscopic myotomy perioperative outcomes. Besides, subgroup analyses were performed to assess the long-term outcomes of the studies with a follow-up time\u2009&amp;gt;\u200924\u00a0months. To verify heterogeneity, the I2 test was used. The random effects were applied, and the fixed model was evaluated as sensitivity analysis. To assess risk of bias and certainty of evidence, the tools ROBINS-I and GRADE were used, respectively. Registration number: CRD42020199667. Results: Sixteen articles were selected, encompassing 350 patients. The mean age ranged from 36 to 61\u00a0years old, and the mean follow-up ranged from 16 to 109\u00a0months. Complications rate was 0.08 (CI: 0.040\u20130.153; P\u2009=\u20090.01). Need for retreatment rate was 0.128 (CI: 0.031\u20130.409; P\u2009=\u20090.01). The probability of good or excellent outcomes after myotomy was 0.762 (CI: 0.703\u20130.812; P\u2009&amp;lt;\u20090.01). Postoperative mortality rate was 0.008 (CI: 0.004\u20130.015; P\u2009&amp;lt;\u20090.01). Conclusion: Surgical myotomy is an option for avoiding esophagectomy in achalasia, with a low morbi-mortality rate and good results. It is effective for most patients and only a minority will demand retreatment.<\/jats:p>","DOI":"10.1093\/dote\/doab053","type":"journal-article","created":{"date-parts":[[2021,8,6]],"date-time":"2021-08-06T04:20:15Z","timestamp":1628223615000},"source":"Crossref","is-referenced-by-count":12,"title":["Myotomy in sigmoid megaesophagus: is it applicable? A systematic review and meta-analysis"],"prefix":"10.1093","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9157-6536","authenticated-orcid":false,"given":"Marina Feliciano","family":"Orlandini","sequence":"first","affiliation":[{"name":"Department of Evidence-Based Medicine, Centro Universit\u00e1rio Lus\u00edada, Santos, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Carolina Andrade","family":"Serafim","sequence":"additional","affiliation":[{"name":"Department of Evidence-Based Medicine, Centro Universit\u00e1rio Lus\u00edada, Santos, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Let\u00edcia Nogueira","family":"Datrino","sequence":"additional","affiliation":[{"name":"Department of Evidence-Based Medicine, Centro Universit\u00e1rio Lus\u00edada, Santos, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6208-3743","authenticated-orcid":false,"given":"Guilherme","family":"Tavares","sequence":"additional","affiliation":[{"name":"Department of Evidence-Based Medicine, Centro Universit\u00e1rio Lus\u00edada, Santos, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca Schilir\u00f3","family":"Trist\u00e3o","sequence":"additional","affiliation":[{"name":"Department of Evidence-Based Medicine, Centro Universit\u00e1rio Lus\u00edada, Santos, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clara Lucato","family":"dos Santos","sequence":"additional","affiliation":[{"name":"Department of Evidence-Based Medicine, Centro Universit\u00e1rio Lus\u00edada, Santos, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wanderley Marques","family":"Bernardo","sequence":"additional","affiliation":[{"name":"Department of Evidence-Based Medicine, Centro Universit\u00e1rio Lus\u00edada, Santos, Brazil"},{"name":"Department of Evidence-Based Medicine, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Tustumi","sequence":"additional","affiliation":[{"name":"Department of Evidence-Based Medicine, Centro Universit\u00e1rio Lus\u00edada, Santos, Brazil"},{"name":"Department of Evidence-Based Medicine, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Department of Surgery, Hospital Israelita Albert Einstein, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,8,5]]},"reference":[{"key":"2021101106135915900_ref1","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1007\/s11605-019-04264-3","article-title":"Revisional surgery in patients with recurrent dysphagia after heller 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