Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis

Peroral endoscopic myotomy (POEM) is an evolving therapeutic modality for achalasia. We aim to determine efficacy of POEM for the treatment of achalasia and compare it with laparoscopic Heller’s myotomy (LHM).

Systematic review and meta-analyses was conducted on 19 studies using POEM for achalasia. Pubmed, Medline, Cochrane, and Ovid databases, were searched using the terms ‘achalasia’, ‘POEM’, ‘peroral endoscopic myotomy’, ‘per oral endoscopic myotomy’, and ‘per-oral endoscopic myotomy’. Reduction in Eckhart’s score and lower esophageal sphincter (LES) pressure were the main outcome measures.

A total of 1,045 patients underwent POEM in 29 studies. Ninety patients undergoing POEM was compared with 160 undergoing LHM in five studies. Nineteen and 14 studies, respectively, evaluated for Eckhart’s score and LES pressure. There was significant reduction in Eckhart’s score and LES pressure with effect sizes of −7.95 (p < 0.0001) and −7.28 (p < 0.0001), respectively. There was significant heterogeneity among the studies [(Q = 83.06; I ² = 78.33 %; p < 0.0001) for Eckhart’s score and (Q = 61.44; I ² = 75.68 %; p < 0.0001) for LES pressure]. There were no differences between POEM and LHM in reduction in Eckhart’s score, post-operative pain scores and analgesic requirements, length of hospital stay, adverse events, and symptomatic gastroesophageal reflux/reflux esophagitis. Operative time was significantly lower for POEM.

POEM is effective for achalasia and has similar outcomes as LHM. Multicenter randomized trials need to be conducted to further compare the efficacy and safety of POEM between treatment naïve achalasia patients and those who failed treatment.