Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

Abstract

Background and study aims Peroral endoscopic myotomy (POEM) is increasingly being used as the preferred treatment option for achalasia. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of POEM versus pneumatic balloon dilation (PD). Methods We performed a comprehensive review of studies that reported clinical outcomes of POEM and PD for the treatment of achalasia. Measured outcomes included clinical success (improvement of symptoms based on a validated scale including an Eckardt score ≤ 3), adverse events, and post-treatment gastroesophageal reflux disease (GERD). Results Sixty-six studies (6268 patients) were included in the final analysis, of which 29 studies (2919 patients) reported on POEM and 33 studies (3050 patients) reported on PD and 4 studies (299 patients) compared POEM versus PD. Clinical success with POEM was superior to PD at 12, 24, and 36 months (92.9 %, vs 76.9 % P = 0.001; 90.6 % vs 74.8 %, P = 0.004; 88.4 % vs 72.2 %, P = 0.006, respectively). POEM was superior to PD in type I, II and III achalasia (92.7 % vs 61 %, P = 0.01; 92.3 % vs 80.3 %, P = 0.01; 92.3 %v 41.9 %, P = 0.01 respectively)Pooled OR of clinical success at 12 and 24 months were significantly higher with POEM (8.97; P = 0.001 & 5.64; P = 0.006). Pooled OR of GERD was significantly higher with POEM (by symptoms: 2.95, P = 0.02 and by endoscopic findings: 6.98, P = 0.001). Rates of esophageal perforation (0.3 % vs 0.6 %, P = 0.8) and significant bleeding (0.4 % vs 0.7 %, P = 0.56) were comparable between POEM and PD groups. Conclusions POEM is more efficacious than PD in the treatment of patients with achalasia during short-term and long-term follow-up, albeit with higher risk of abnormal esophageal acid exposure.

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

“…In this context, a slowly progressive trend towards decreased efficacy must be taken into account, as was also reported for LHM and PD, and may be explainable by the degenerative nature of achalasia and the fact that all available treatments are rather palliative than curative [25]. According to another metanalysis of short-and medium-term studies, clinical success rate with POEM at 12, 24, and 36 months was 92.9 %, 90.6 % and 88.4 % respectively, in line with our results and confirming an only slight decrease of efficacy over time [26].…”

Comparison of fully coated anti-reflux metal stenting and per-oral endoscopic myotomy in patients with achalasia: a propensity score-matched retrospective study

“…Maybe it implies POEM has a better further long-term curative efficacy than stent. POEM has similar efficacy to first-line treatment of LHM, and the cure success rate is higher than that of PD [ 28 ]; the incidence of serious adverse events, but the incidence of GERD higher [ 29 ]. Recently, studies showed that the length of circular myotomy is related to the occurrence of GERD complications.…”

Initial experience with peroral endoscopic myotomy in Bulgaria: case series

“…Nowadays, there are meta-analyses comparing it to the Heller myotomy. They include thousands of patients [7] and studies, where follow-ups are performed for up to 10 years [8] . In a randomized controlled trial, comparing POEM to Heller myotomy, clinical success at the two years follow-up was observed at 83% of the POEM group and at 81.7% of the surgical myotomy group.…”

“…[9] Moreover, when measuring clinical outcomes of POEM and pneumatic dilatation (PD), the second most used endoscopic technique for treatment of achalasia, the patients that underwent POEM showed significantly better shortand long-term outcomes. [10] Since fundoplication is not performed along with POEM, as it is with Heller myotomy, the development of gastroesophageal reflux disease was a major concern. Studies show that the frequency of GERD differs according to the method used for its diagnosis -symptom development, pH monitoring and endoscopic findings.…”