The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e2 

Full Thickness Versus Circular Peroral 
Myotomy in the Treatment of Esophageal 
Achalasia: A Systematic Review and Meta-
Analysis 
Wasef Sayeh, MD1*, Sami Ghazaleh, MD2, Azizullah Beran, MD1, Mohammad Safi, 
MD1, Dipen Patel, MD, MBA1, Justin Chaung, MD1, Saif-Eddin Malhas, MD1, 
Amna Iqbal, MD1, Ziad Abuhelwa, MD1, Waleed Khokher, MD1, Omar Sajdeya, 
MD1, Anas Alsughayer, MD1, Anas Renno, MD2, Ajit Ramadugu, MD2, Ali Nawras; 
MD2

1Division of Internal Medicine, Department of Medicine, The University of Toledo, 
Toledo, OH 43614 
2Division of Gastroenterology and Hepatology, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: wasef.sayeh@utoledo.edu

Published: 05 May 2023 

Introduction: Peroral endoscopic myotomy (POEM) is an effective procedure that is used to treat 
esophageal achalasia. Early studies recommended a circular myotomy where the circular muscle layer is 
cut with preservation of the longitudinal layer. Recent studies have investigated full thickness myotomy 
as a possible alternative. 

Methods: We performed a comprehensive search in the databases of PubMed/MEDLINE, Embase, and 
the Cochrane Central Register of Controlled Trials from inception through April 20th, 2022. We 
considered only randomized controlled trials. The primary outcome was clinical success. The secondary 
outcomes were the occurrence of subcutaneous emphysema and post-procedure reflux symptoms. The 
random-effects model was used to calculate the risk ratios (RR), mean differences (MD), and confidence 
intervals (CI). A p value <0.05 was considered statistically significant.  

Results: Six randomized controlled trials involving 774 patients were included in the meta-analysis. The 
rate of clinical success was not statistically different between the two groups (RR 1.02, 95% CI 0.98-
1.06, p = 0.45, I2 = 0%) (Figure 1a). The rate of subcutaneous emphysema was significantly lower in the 
full thickness group (RR 0.62, 95% CI 0.43-0.89, p = 0.01, I2 = 0%) (Figure 1b). The rate of post-
procedure reflux symptoms was not statistically different between the two groups (RR 1.10, 95% CI 
0.60-2.02, p = 0.75, I2 = 22%).  

https://dx.doi.org/10.46570/utjms.vol11-2023-722 

https://dx.doi.org/10.46570/utjms.vol11-2023-722
mailto:wasef.sayeh@utoledo.edu


https://dx.doi.org/10.46570/utjms.vol11-2023-722 UTJMS 11(1):e1-e2 

https://dx.doi.org/10.46570/utjms.vol11-2023-722 2 ©2023 UTJMS 

Discussion: Our meta-analysis demonstrated that clinical success and the post-procedure reflux 
symptoms were both not statistically different between full thickness and circular PEOM. However, 
subcutaneous emphysema was significantly lower in the full thickness myotomy group. 

https://dx.doi.org/10.46570/utjms.vol11-2023-722
https://dx.doi.org/10.46570/utjms.vol11-2023-722