Long-term outcomes of peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis

Edoardo Vespa; Gaia Pellegatta; Viveksandeep T. Chandrasekar; Marco Spadaccini; Harsh Patel; Roberta Maselli; Piera A. Galtieri; Elisa Carlani; Prateek Sharma; Cesare Hassan; Alessandro Repici

doi:10.1055/a-1894-0147

Endoscopy, Table of Contents

Endoscopy 2023; 55(02): 167-175
DOI: 10.1055/a-1894-0147

Systematic review

Long-term outcomes of peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis

Edoardo Vespa ‡^*

¹Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

²Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

,

Gaia Pellegatta‡^*

¹Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

,

Viveksandeep T. Chandrasekar

³Department of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, United States

,

Marco Spadaccini

¹Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

²Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

,

Harsh Patel

⁴Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana, United States

,

Roberta Maselli

¹Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

²Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

,

Piera A. Galtieri

¹Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

,

Elisa Carlani

¹Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

,

Prateek Sharma

⁵Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, United States

,

Cesare Hassan

¹Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

²Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

,

Alessandro Repici

¹Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

²Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

› Author Affiliations

Abstract

Background The long-term outcomes of esophageal peroral endoscopic myotomy (POEM) are still unknown.

Methods We 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 12/24/36 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 %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 one 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 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.

Full Text

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Supplementary Material

Supplementary material