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

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%; I-2 = 73.1 %). The symptomatic reflux pooled rate was 22.0% (95%CI 14.4%-29.5%; I-2 = 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%; I-2 = 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.