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Mid-Term and Long-Term Outcomes of Peroral Endoscopic Myotomy for the Treatment of Achalasia: A Systematic Review and Meta-Analysis

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Abstract

Background and Aims

Peroral endoscopic myotomy (POEM) achieves a satisfactory short-term clinical response in patients with achalasia. However, data on mid- and long-term clinical outcomes are limited. We aimed to assess the mid- and long-term efficacy and safety of POEM in achalasia patients.

Methods

Using the pre-designed search strategy, we identified relevant studies that evaluated the efficacy and safety of POEM with a minimum of 2-year follow-up in the Embase, Cochrane, and PubMed databases from inception to January 2021. Primary outcome was pooled mid- and long-term clinical success rate based on the Eckardt score. Secondary outcome was pooled long-term reflux-related adverse events.

Results

A total of 21 studies involving 2,698 patients were included. Overall, the pooled clinical success rates with 2-, 3-, 4-, and 5-year follow-ups were 91.3% (95% confidence interval [CI] 88.4–93.6%), 90.4% (95% CI 88.1–92.2%), 89.8% (95% CI 83.6–93.9%), and 82.2% (95% CI 76.6–86.7%), respectively. Besides, the pooled long-term clinical success rates for type I, II, and III achalasia were 86.1% (95% CI 80.9–90.1%; I2 = 0%), 87.9% (95% CI 84.2–90.8%; I2 = 48.354%), and 83.9% (95% CI 72.5–91.2%; I2 = 0%), respectively. Moreover, the pooled incidence of symptomatic reflux and reflux esophagitis was 23.9% (95% CI 18.7–29.9%) and 16.7% (95% CI 11.9–23.1%), respectively.

Conclusions

POEM is associated with a long-term clinical success of 82.2% after 5 years of follow-up. Randomized control trials comparing POEM with laparoscopic Heller myotomy or pneumatic dilation with longer follow-up periods are needed to further demonstrate the long-term safety and efficacy of POEM.

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Acknowledgments

This study is independent research funded by the following grants: Medical Science and Technology Plan Projects of Zhejiang Province (No. 2017196257), Youth Foundation of Southwest Medical University (No. 0903-00031099), and Doctoral Research Start-up Funding Project of Affiliated Hospital of Southwest Medical University (No. 16229).

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Author notes

  1. Han Zhang, Xinyi Zeng and Shu Huang have contributed equally to this study.

Authors and Affiliations

  1. Department of Gastroenterology, The Affliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan, China

    Han Zhang, Xinyi Zeng, Lei Shi, Huifang Xia, Jiao Jiang, Wensen Ren, Yan Peng, Muhan Lü & Xiaowei Tang

  2. Department of Gastroenterology, The People’s Hospital of Lianshui, Huaian, China

    Shu Huang

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  1. Han Zhang
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Zhang, H., Zeng, X., Huang, S. et al. Mid-Term and Long-Term Outcomes of Peroral Endoscopic Myotomy for the Treatment of Achalasia: A Systematic Review and Meta-Analysis. Dig Dis Sci 68, 1386–1396 (2023). https://doi.org/10.1007/s10620-022-07720-4

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