Clinical outcomes of peroral endoscopic myotomy in non-achalasia esophageal motility disorders: a systematic review and meta-analysis

Aims: Peroral endoscopic myotomy (POEM) has been successfully performed in patients with non-achalasia esophageal motility disorders (NAEMDs), including esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), hypercontractile esophagus [jackhammer esophagus (JE)], etc. We aimed to conducted a systematic review to evaluate the efficacy and safety of POEM in these patients.
Methods: PubMed, Embase, and Cochrane Library databases were searched for studies on POEM in NAEMDs from database inception to April 30th, 2021. The pooled rates for technical success, clinical success, and adverse events (AEs) were calculated.
Results: A total of 11 observational studies with 213 patients were included in the analysis. The mean methodological index for non-randomized studies (MINORS) score of included studies was 11.64 ± 1.61, which indicates a fair quality of evidence for non-randomized studies. The pooled rates of technical success and clinical success for POEM were 96.8% (95% confidence interval [CI], 92.8%-98.6%, I² = 0%) and 84.7% (95% CI, 79.1%-89.0%, I² = 0%), respectively. The pooled rate of AEs for POEM was 16.4% (95% CI, 10.7%-24.3%, I² = 0%). The pooled rates of post-procedure gastroesophageal reflux disease (GERD) by symptoms, esophagogastroduodenoscopy (EGD), and pH were 38.0%, 35.2%, and 41.1%, respectively. The pooled rates of clinical success for EGJOO, DES, and JE were 86.0%, 89.3%, and 77.4%, respectively.
Conclusions: POEM could be an effective and safe therapeutic modality for NAEMDs.