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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  ‡   *
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
Gaia Pellegatta‡   *
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Viveksandeep T. Chandrasekar 
3   Department of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, United States
,
Marco Spadaccini
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
Harsh Patel
4   Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana, United States
,
Roberta Maselli
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
Piera A. Galtieri
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Elisa Carlani
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
,
Prateek Sharma
5   Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, United States
,
Cesare Hassan
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
,
Alessandro Repici
1   Department of Gastroenterology and Hepatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
2   Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Comments on: “Long-term outcomes of peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis”Endoscopy 2023; 55(03): 297-297
DOI: 10.1055/a-1929-1522

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.

* Co-first authors.


Tables 1 s–3 s, Figs. 1 s–10 s



Publikationsverlauf

Eingereicht: 28. November 2021

Angenommen nach Revision: 07. Juli 2022

Accepted Manuscript online:
07. Juli 2022

Artikel online veröffentlicht:
31. August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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