CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(07): E1097-E1107
DOI: 10.1055/a-1483-9406
Original article

Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up

Andrew Ofosu
 1  Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
,
Babu P. Mohan
 2  Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, United States
,
Yervant Ichkhanian
 3  Internal Medicine, Henry Ford University Medical Center, Detroit, Michigan, United States
,
Maen Masadeh
 4  Kaiser Permanente Northern California, California, United States
,
John Febin
 1  Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
,
Mohamed Barakat
 1  Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
,
Daryl Ramai
 1  Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
,
Saurabh Chandan
 5  Gastroenterology and Hepatology, University of Nebraska, United States
,
Gulara Haiyeva
 6  Beneficts Hospital Inc., Great Falls, Montana, United States
,
Shahab R. Khan
 7  Gastroenterology, Rush University Medical Center, Chicago, Illinois, United States
,
Mohamad Aghaie Meybodi
 8  Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore, Maryland, United States
,
Antonio Facciorusso
 9  Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
,
Alessandro Repici
10  Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
,
Sachin Wani
11  Gastroenterology, University of Colorado School of Medicine, Aurora, Colorado, United States
,
Nirav Thosani
12  Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, Texas, United States
,
Mouen A. Khashab
 8  Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore, Maryland, United States
› Author Affiliations

Abstract

Background and study aims Peroral endoscopic myotomy (POEM) is increasingly being used as the preferred treatment option for achalasia. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of POEM versus pneumatic balloon dilation (PD).

Methods We performed a comprehensive review of studies that reported clinical outcomes of POEM and PD for the treatment of achalasia. Measured outcomes included clinical success (improvement of symptoms based on a validated scale including an Eckardt score ≤ 3), adverse events, and post-treatment gastroesophageal reflux disease (GERD).

Results Sixty-six studies (6268 patients) were included in the final analysis, of which 29 studies (2919 patients) reported on POEM and 33 studies (3050 patients) reported on PD and 4 studies (299 patients) compared POEM versus PD. Clinical success with POEM was superior to PD at 12, 24, and 36 months (92.9 %, vs 76.9 % P = 0.001; 90.6 % vs 74.8 %, P = 0.004; 88.4 % vs 72.2 %, P = 0.006, respectively). POEM was superior to PD in type I, II and III achalasia (92.7 % vs 61 %, P = 0.01; 92.3 % vs 80.3 %, P = 0.01; 92.3 %v 41.9 %, P = 0.01 respectively)

Pooled OR of clinical success at 12 and 24 months were significantly higher with POEM (8.97; P = 0.001 & 5.64; P = 0.006). Pooled OR of GERD was significantly higher with POEM (by symptoms: 2.95, P = 0.02 and by endoscopic findings: 6.98, P = 0.001). Rates of esophageal perforation (0.3 % vs 0.6 %, P = 0.8) and significant bleeding (0.4 % vs 0.7 %, P = 0.56) were comparable between POEM and PD groups.

Conclusions POEM is more efficacious than PD in the treatment of patients with achalasia during short-term and long-term follow-up, albeit with higher risk of abnormal esophageal acid exposure.

Supplementary material



Publication History

Received: 22 July 2020

Accepted: 23 November 2020

Publication Date:
21 June 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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