{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T20:12:30Z","timestamp":1793045550598,"version":"4.5.0"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T00:00:00Z","timestamp":1724976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,28]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Peroral endoscopic myotomy (POEM) is an established treatment for achalasia, yet there is still a lack of technical standardization. No clear definition of \u2018long\u2019, \u2018standard\u2019, or \u2018short\u2019 POEM exists to date. We conducted a systematic review with meta-analysis to analyze current POEM length standards. We included studies reporting technical details of POEM, in which no definite or comparative myotomy length was intentionally adopted (standard myotomy). The primary outcome was the pooled mean total myotomy length. Sub-group analyses were performed to explore heterogeneity across studies. From the initial 7172 records, 31 studies with 3023 patients were included. Pooled mean of total myotomy length was 10.39\u00a0cm (95% CI 10.06\u201310.71; I2 99.3%). Pooled mean of esophageal and gastric myotomy length, provided by 17 studies, was 7.11\u00a0cm (95% CI 6.51\u20137.71; I2 99.8%) and 2.81\u00a0cm (95% CI 2.41\u20133-22; I2 99.8%), respectively. On subgroup analysis for achalasia subtypes, pooled mean length in non-spastic achalasia (type I and II) was 10.17\u00a0cm (95% CI 9.91\u201310.43; I2 94.2%), while in type III it was 14.02\u00a0cm (95% CI 10.59\u201317.44; I2 98.9%). Pooled mean myotomy length for studies conducted between 2014\u20132020 was 10.53\u00a0cm (95% CI, 10.22\u201310.84; I2 99.1%) and 9.74\u00a0cm (95% CI, 7.95\u201311.54; I2 99.7%) in 2021\u20132022. Myotomy length during a \u2018standard\u2019 POEM is 10.4\u00a0cm, remaining over 10\u00a0cm in non-spastic achalasia. The high heterogeneity across studies confirms that the POEM technique needs further standardization. We found no significant time trend towards adopting short POEM, despite recent evidence supporting its use.<\/jats:p>","DOI":"10.1093\/dote\/doae069","type":"journal-article","created":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T19:51:31Z","timestamp":1723146691000},"source":"Crossref","is-referenced-by-count":8,"title":["Standard length of peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5573-447X","authenticated-orcid":false,"given":"Edoardo","family":"Vespa","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele , Milan,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Barchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele , Milan,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Vito","family":"Mandarino","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele , Milan,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Fasulo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele , Milan,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Caterina","family":"Fratto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele , Milan,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro","family":"Passaretti","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele , Milan,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Azzolini","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele , Milan,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3187-2894","authenticated-orcid":false,"given":"Edoardo Vincenzo","family":"Savarino","sequence":"additional","affiliation":[{"name":"Department of Surgery , Oncology, and Gastroenterology, , Padua,","place":["Italy"]},{"name":"University of Padua , Oncology, and Gastroenterology, , Padua,","place":["Italy"]},{"name":"Gastroenterology Unit , Department of Surgery, Oncology and Gastroenterology, , Padua,","place":["Italy"]},{"name":"Azienda Ospedale Universit\u00e0 di Padova , Department of Surgery, Oncology and Gastroenterology, , Padua,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvio","family":"Danese","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele , Milan,","place":["Italy"]},{"name":"Faculty of Medicine , Department of Gastroenterology and Endoscopy, , Milan,","place":["Italy"]},{"name":"Universit\u00e0 Vita-Salute San Raffaele , Department of Gastroenterology and Endoscopy, , Milan,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,30]]},"reference":[{"key":"2024112912521838400_ref1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/s41572-022-00356-8","article-title":"Achalasia","volume":"8","author":"Savarino","year":"2022","journal-title":"Nat Rev Dis 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achalasia","volume":"33","author":"Kane","year":"2019","journal-title":"Surg Endosc"},{"key":"2024112912521838400_ref52","article-title":"Precision endoscopy in peroral myotomies for motility disorders of the upper gastrointestinal tract: current insights and prospective avenues-a comprehensive review","volume":"13","author":"Mandarino","year":"2023","journal-title":"Life (Basel)"},{"key":"2024112912521838400_ref53","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1016\/j.gie.2020.10.006","article-title":"Safety and efficacy of peroral endoscopic myotomy with standard myotomy versus short myotomy for treatment-na\u00efve patients with type II achalasia: a prospective randomized trial","volume":"93","author":"Gu","year":"2021","journal-title":"Gastrointest Endosc"},{"key":"2024112912521838400_ref54","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.gie.2020.07.041","article-title":"Blown-out myotomy: an adverse event of laparoscopic heller myotomy and peroral 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