Mid- and long-term outcomes of peroral endoscopic myotomy for the treatment of achalasia: A systematic review and meta-analysis Poster Award Travel Award

Aims: Current evidence has shown that peroral endoscopic myotomy (POEM) has a satisfactory short-term clinical effect for achalasia patient. This study aimed to determine the mid- and long-term outcomes of patients undergoing POEM.
Methods: We searched the Embase, Cochrane, and PubMed databases from inception to January 2021 using the designed search strategy. Data on technical and clinical success, adverse events, lower esophageal sphincter (LES) pressure were collected.
Results: A total of 21 studies with 2698 achalasia patients were included. Overall, the pooled technical success and adverse event rate of POEM were 98.6% (95% confidence interval [CI], 97.9%-99.0%) and 16.3% (95% CI, 11.4 %-22.8%), respectively. The pooled results of clinical success rates at the 2-, 3-, 4-, and 5-year follow-up evaluations were 90.9% (95% CI, 88.2%-93.1%), 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. The pooled symptomatic reflux and reflux esophagitis rates were 25.9% (95% CI, 21.6%-30.7%) and 21.1% (95% CI, 15.2%-28.5%), respectively. During the follow-up, the mean Eckardt score was significantly decreased by 5.90 points (95% CI, 5.40-6.41; p<0.001, I²=91%). The mean LES pressure was significantly reduced by 27.61 mmHg (95% CI, 26.17-29.05 mmHg; p<0.001, I²=91%).
Conclusions: POEM is a highly safe and effective treatment for esophageal achalasia with favorable long-term outcomes.