Peroral Endoscopic Myotomy for Achalasia Is Effective up to 4 Years

Peroral Endoscopic Myotomy for Achalasia Is Effective up to 4 Years

Prateek Sharma, MD, FASGE, reviewing Vespa E, et al. Endoscopy 2022 Jul 7.

Recent guidelines have recommended peroral endoscopic myotomy (POEM) as first-line therapy for all subtypes of achalasia, given that POEM and laparoscopic Heller myotomy have comparable efficacy and safety. POEM has been shown to have excellent short- to medium-term results; however, long-term efficacy is still being established.  

This systematic review included studies with a median follow-up duration of at least 36 months, patients with a diagnosis of manometry-defined achalasia, and availability of post-POEM efficacy and safety outcomes data. The analysis comprised 11 articles with 2273 patients with achalasia: 27.9% with type I, 58.4% with type II, and 10.2% with type III. Fifty percent of patients were male, the mean age was 48.1 years (± 6.8 years), and the mean disease duration was 59.3 months (± 23.7 months). The median follow-up duration was 48 months (interquartile range, 45-60 months). The mean myotomy length was 11.2 cm (± 2.2 cm). 

The overall pooled clinical success rate was 87.3% (95% confidence interval [CI], 83.6%-91.0%), and the pooled post-POEM symptomatic reflux rate was 22% (95% CI, 14.4%-29.5%). No significant efficacy loss was noted over the time period of 4 years. The pooled rate of severe adverse events was 1.5% (95% CI, 0.5%-2.5%).

Prateek Sharma, MD, FASGE

COMMENT

Treatment of achalasia with POEM is effective and safe over an average follow-up period of at least 4 years. Success rates of 87% can be expected in the treated patients, with approximately 20% of the treated patients experiencing post-POEM GERD symptoms.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Vespa E, Pellegatta G, Thoguluva Chandrasekar V, et al. Long-term outcomes of per-oral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis. Endoscopy 2022 Jul 7. (Epub ahead of print) (https://doi.org/10.1055/a-1894-0147)

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