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 %; I2  = 73.1 %). The symptomatic reflux pooled rate was 22.0 % (95 %CI 14.4 %-29.5 %; I2  = 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 %; I2  = 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.
Competing Interests: R. Maselli: consulting for Fujifilm, ERBE. P. Sharma: consultant for Medtronic, Olympus, Boston Scientific, Fujifilm, and Lumendi. He receives grant support from Ironwood, Erbe, Docbot, Cosmo pharmaceuticals, and CDx labs. C. Hassan: consulting fees from Fujifilm, Medtronic. A. Repici: consulting fees from Medtronic, Fujifilm, Boston Scientific, ERBE. All other authors declare that no conflicts of interest exist.
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