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CC BY 4.0 · Endosc Int Open 2025; 13: a26215421
DOI: 10.1055/a-2621-5421
Review

Gastroesophageal reflux disease over time in endoscopic versus surgical myotomy for treatment of achalasia: Systematic review and meta-analysis

Angelo So Taa Kum 
1   Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Beanie Conceição Medeiros Nunes
1   Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Eduardo Turiani Hourneaux Moura
1   Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Matheus Cavalcante Franco
2   Endoscopy Unit, Hospital Sírio-Libanês, Brasília, Brazil
,
Eduardo Guimarães Hourneaux de Moura 
1   Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Abstract

Background and study aims

Achalasia, a motor disorder of the esophagus, is treated with peroral endoscopic myotomy (POEM) or Heller myotomy with fundoplication (HMF). Although POEM lacks an antireflux mechanism, potentially increasing postoperative gastroesophageal reflux disease (GERD), limiting the endoscopic approach, this difference in GERD tends to diminish over time. The objective of this study was to compare GERD over time, the need for regular gastric acid suppression therapy (GAST), effectiveness, and safety between POEM and HMF in treating achalasia.

Methods

A systematic review and meta-analysis was conducted by searching mainly in MEDLINE, EMBASE, and ClinicalTrials.gov. Primary outcomes included early (< 12 months) and late (≥ 12 months) evaluations of postoperative GERD based on endoscopic criteria of the Lyon Consensus 2.0, and GAST. Secondary outcomes included clinical success (Eckardt score ≤ 3), procedure time, length of stay, and major adverse events (AEs) (Clavien-Dindo classification ≥ 2)

Results

Thirty-two observational studies and two randomized trials were included, totaling 14,125 patients. GERD was higher in POEM in early evaluation (risk ratio [RR] = 3.03; PP < 0.01). GERD occurrence was similar between POEM and HMF in the late evaluation (P = 0.30). Higher GAST was observed in POEM (RR = 1.35; P = 0.02). Secondly, clinical success was higher in POEM (RR = 1.06; P = 0.01), with shorter procedure time (median 39.53 minutes; P < 0.01) and shorter length of stay (mean different = -0.51 day; P = 0.03), with similar major AEs (P = 0.81) compared with HMF.

Conclusions

A higher rate of early GERD is observed in POEM compared with HMF, with the difference waning over time and reaching equivalence after 12 months, despite a higher rate of GAST in the endoscopic group. POEM also exhibited effectiveness and safety comparable to the surgical approach.

Keywords

Endoscopy Upper GI Tract - Reflux disease - Motility / achalasia - POEM - GI surgery

Supplementary Material



Publikationsverlauf

Eingereicht: 20. Dezember 2024

Angenommen nach Revision: 13. Mai 2025

Accepted Manuscript online:
26. Mai 2025

Artikel online veröffentlicht:
17. Juni 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Angelo So Taa Kum, Beanie Conceição Medeiros Nunes, Eduardo Turiani Hourneaux Moura, Matheus Cavalcante Franco, Eduardo Guimarães Hourneaux de Moura. Gastroesophageal reflux disease over time in endoscopic versus surgical myotomy for treatment of achalasia: Systematic review and meta-analysis. Endosc Int Open 2025; 13: a26215421.
DOI: 10.1055/a-2621-5421
 

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