Peroral Endoscopic Myotomy for Achalasia Is Effective up to 4 Years

Recent guidelines have recommended peroral endoscopic myotomy (POEM) as first-line therapy for all subtypes of achalasia, given that POEM and laparoscopic Heller myotomy have comparable efficacy and safety. POEM has been shown to have excellent short- to medium-term results; however, long-term efficacy is still being established.  

This systematic review included studies with a median follow-up duration of at least 36 months, patients with a diagnosis of manometry-defined achalasia, and availability of post-POEM efficacy and safety outcomes data. The analysis comprised 11 articles with 2273 patients with achalasia: 27.9% with type I, 58.4% with type II, and 10.2% with type III. Fifty percent of patients were male, the mean age was 48.1 years (± 6.8 years), and the mean disease duration was 59.3 months (± 23.7 months). The median follow-up duration was 48 months (interquartile range, 45-60 months). The mean myotomy length was 11.2 cm (± 2.2 cm). 

The overall pooled clinical success rate was 87.3% (95% confidence interval [CI], 83.6%-91.0%), and the pooled post-POEM symptomatic reflux rate was 22% (95% CI, 14.4%-29.5%). No significant efficacy loss was noted over the time period of 4 years. The pooled rate of severe adverse events was 1.5% (95% CI, 0.5%-2.5%).