Esophagus to Small Intestine
Long-term outcomes of peroral endoscopic myotomy for achalasia: A systematic review and meta-analysis
Background: The long-term outcomes of esophageal peroral endoscopic myotomy (POEM) are still unknown.
Methods: The authors searched electronic databases (Medline/PubMed, Embase, Scopus) for studies assessing outcomes after POEM for esophageal achalasia with a minimum median follow-up duration of 36 months. Pooled rates of clinical success and postoperative reflux were calculated and compared with the same values at 12, 24 and 36 months when available. Subgroup analyses were performed to explore the interstudy heterogeneity.
Results: From 1528 initial records, 11 studies (2017–2021) were included. A total of 2342 patients (age 48.1 [SD 6.8] years; 50.1% males) with a median follow-up of 48 months (interquartile range, 45–60) were analyzed. The pooled clinical success rate was 87.3% (95% confidence interval [CI]: 83.6–91.0%; I² = 73.1%). The symptomatic reflux pooled rate was 22.0% (95% CI: 14.4–29.5%; I² = 92.7%). Three cases of peptic strictures and 1 Barrett’s esophagus were reported. The pooled rate of severe adverse events was 1.5% (95% CI: 0.5–2.5%; I² = 52.8%).
Conclusions: Long-term clinical efficacy of peroral endoscopic myotomy (POEM) persisted in 87% of patients with achalasia. Post-POEM symptomatic reflux remained stable over time. The risk for Barrett’s esophagus and peptic strictures appeared minimal.