{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T20:04:01Z","timestamp":1787169841099,"version":"build-2736575974"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,7]]},"abstract":"\n Background:<\/jats:title>\n Peroral endoscopic myotomy (POEM) is an established modality of treatment for achalasia cardia. Considerable variations exist in the technique of POEM with respect to the length and orientation of the myotomy. In this systematic review and meta-analysis, we compared the outcomes of short versus long myotomy during POEM.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We searched multiple databases from January 2010 to March 2021 to identify studies reporting on POEM. We selected studies that reported on comparative outcomes of POEM using short versus long myotomy. We performed a comparative analysis of clinical success, procedural duration, gastroesophageal reflux disease (GERD), and adverse events with short and long myotomy in POEM by meta-analysis.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n A total of 521 patients from five studies in which 241 patients were treated with short and 280 patients with long myotomy approaches were analyzed. The pooled rate for clinical success gave an odds ratio (OR) of 1.27 (95% confidence interval [CI] 0.50\u20133.26; I\n 2<\/jats:sup>\n = 0;\n P<\/jats:italic>\n = 0.62); for hospital stay OR 0.22 (95% CI \u2212 0.03 to 0.46; I\n 2<\/jats:sup>\n = 0;\n P<\/jats:italic>\n = 0.08); for GERD by esophagogastroduodenoscopy (EGD) OR 0.58 (95% CI 0.31\u20131.07; I\n 2<\/jats:sup>\n = 0;\n P<\/jats:italic>\n = 0.08), and for adverse events OR 0.67 (95% CI 0.29\u20131.53; I\n 2<\/jats:sup>\n = 51;\n P<\/jats:italic>\n = 0.34). Abnormal esophageal acid exposure was less frequent with OR 0.45 (95% CI 0.22\u20130.90;\n P<\/jats:italic>\n = 0.02; I\n 2<\/jats:sup>\n = 0) and the procedure duration was significantly shorter in the short myotomy group with OR \u2212 0.76 (95% CI \u2212 1.00 to \u2212 0.52; I\n 2<\/jats:sup>\n = 43;\n P<\/jats:italic>\n =0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Short myotomy and long myotomy in POEM seem comparable with each other in terms of clinical success and adverse events. Short myotomy is associated with significantly shorter procedural duration and possibly reduced esophageal acid exposure compared with long myotomy.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/sjg.sjg_438_21","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T01:17:18Z","timestamp":1637111838000},"page":"261-267","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":25,"title":["Short versus long esophageal myotomy during peroral endoscopic myotomy"],"prefix":"10.4103","volume":"28","author":[{"given":"Zaheer","family":"Nabi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupjyoti","family":"Talukdar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harshal","family":"Mandavdhare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Nageshwar","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-3-20240829","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1111\/dote.12280","article-title":"Safety and efficacy of the modified peroral endoscopic myotomy with shorter myotomy for achalasia patients: A prospective study","volume":"28","author":"Wang","year":"2015","journal-title":"Dis Esophagus"},{"key":"R2-3-20240829","first-page":"S53","article-title":"Long vs short poem for the treatment of achalasia. Interim analysis of a randomized controlled trial","volume":"50","author":"Familiari","year":"2018","journal-title":"Endoscopy"},{"key":"R3-3-20240829","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1007\/s00464-018-6414-7","article-title":"Safety and efficacy of using a short tunnel versus a standard tunnel for peroral endoscopic myotomy for Ling type IIc and III achalasia: A retrospective study","volume":"33","author":"Li","year":"2019","journal-title":"Surg Endosc"},{"key":"R4-3-20240829","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s10388-020-00739-4","article-title":"Peroral endoscopic shorter versus longer myotomy for the treatment of achalasia: A comparative retrospective study","volume":"17","author":"Huang","year":"2020","journal-title":"Esophagus"},{"key":"R5-3-20240829","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-naive patients with type II achalasia: A prospective randomized trial","volume":"93","author":"Gu","year":"2021","journal-title":"Gastrointest Endosc"},{"key":"R6-3-20240829","doi-asserted-by":"crossref","first-page":"63","DOI":"10.5056\/jnm20022","article-title":"Comparison of short versus long esophageal myotomy in cases with idiopathic achalasia: A randomized controlled trial","volume":"27","author":"Nabi","year":"2021","journal-title":"J Neurogastroenterol Motil"},{"key":"R7-3-20240829","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1001\/archsurg.138.5.490","article-title":"Improved outcome after extended gastric myotomy for achalasia","volume":"138","author":"Oelschlager","year":"2003","journal-title":"Arch Surg"},{"key":"R8-3-20240829","doi-asserted-by":"crossref","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement?","volume":"339","author":"Moher","year":"2009","journal-title":"BMJ"},{"key":"R9-3-20240829","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials?","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"R10-3-20240829","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/1471-2288-5-13","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"5","author":"Hozo","year":"2005","journal-title":"BMC Med Res Methodol"},{"key":"R11-3-20240829","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin Trials"},{"key":"R12-3-20240829","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1097\/SLA.0000000000004830","article-title":"Outcomes of 100 patients more than 4 years after poem for achalasia","volume":"273","author":"Campagna","year":"2021","journal-title":"Ann Surg"},{"key":"R13-3-20240829","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/j.gie.2021.05.014","article-title":"Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U. S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment","volume":"94","author":"Modayil","year":"2021","journal-title":"Gastrointest Endosc"},{"key":"R14-3-20240829","doi-asserted-by":"crossref","first-page":"E409","DOI":"10.1055\/a-1333-1883","article-title":"Long-term clinical results of per-oral endoscopic myotomy (POEM) for achalasia: First report of more than 10-year patient experience as assessed with a questionnaire-based survey","volume":"9","author":"Onimaru","year":"2021","journal-title":"Endosc Int Open"},{"key":"R15-3-20240829","doi-asserted-by":"crossref","first-page":"180","DOI":"10.5056\/jnm20014","article-title":"2019 Seoul consensus on esophageal achalasia guidelines","volume":"26","author":"Jung","year":"2020","journal-title":"J Neurogastroenterol Motil"},{"key":"R16-3-20240829","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.gie.2019.04.231","article-title":"ASGE guideline on the management of achalasia","volume":"91","author":"Khashab","year":"2020","journal-title":"Gastrointest Endosc"},{"key":"R17-3-20240829","first-page":"13","article-title":"European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations United European","volume":"8","author":"Oude Nijhuis","year":"2020","journal-title":"Gastroenterol J"},{"key":"R18-3-20240829","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.14309\/ajg.0000000000000731","article-title":"ACG Clinical Guidelines: Diagnosis and Management of Achalasia","volume":"115","author":"Vaezi","year":"2020","journal-title":"Am J Gastroenterol"},{"key":"R19-3-20240829","doi-asserted-by":"crossref","first-page":"E190","DOI":"10.1055\/s-0043-121877","article-title":"Outcomes of anterior myotomy versus posterior myotomy during POEM: A randomized pilot study","volume":"6","author":"Ramchandani","year":"2018","journal-title":"Endosc Int Open"},{"key":"R20-3-20240829","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.gie.2018.03.009","article-title":"Efficacy of anterior versus posterior per-oral endoscopic myotomy for treating achalasia: a randomized, prospective study","volume":"88","author":"Tan","year":"2018","journal-title":"Gastrointest Endosc"},{"key":"R21-3-20240829","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.gie.2019.07.034","article-title":"Peroral endoscopic myotomy: anterior versus posterior approach: a randomized single-blinded clinical trial","volume":"91","author":"Khashab","year":"2020","journal-title":"Gastrointest Endosc"},{"key":"R22-3-20240829","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1055\/a-1090-0788","article-title":"Anterior versus posterior approach in peroral endoscopic myotomy (POEM): a systematic review and meta-analysis","volume":"52","author":"Mohan","year":"2020","journal-title":"Endoscopy"},{"key":"R23-3-20240829","doi-asserted-by":"crossref","first-page":"E195","DOI":"10.1055\/s-0034-1391668","article-title":"Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: A multicenter comparative study","volume":"3","author":"Kumbhari","year":"2015","journal-title":"Endosc Int Open"},{"key":"R24-3-20240829","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1097\/MCG.0000000000001395","article-title":"Long-term Outcomes of Per-oral Endoscopic Myotomy in Spastic Esophageal Motility Disorders: A Large, Single-Center Study","volume":"55","author":"Nabi","year":"2021","journal-title":"J Clin Gastroenterol"},{"key":"R25-3-20240829","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.gie.2015.06.013","article-title":"Comprehensive analysis of efficacy and safety of peroral endoscopic myotomy performed by a gastroenterologist in the endoscopy unit: A single-center experience","volume":"83","author":"Khashab","year":"2016","journal-title":"Gastrointest Endosc"}],"container-title":["Saudi Journal of Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sjg.sjg_438_21","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:13:58Z","timestamp":1787166838000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sjg.sjg_438_21"}},"subtitle":["A systematic review and meta-analysis of comparative trials"],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.4103\/sjg.sjg_438_21","relation":{},"ISSN":["1319-3767"],"issn-type":[{"value":"1319-3767","type":"print"}],"subject":[],"published":{"date-parts":[[2022,7]]}}}