Systematic review and meta-analysis: Efficacy and safety of POEM for achalasia. Issue 4 (August 2015)

• Record Type: Journal Article
• Authors: Barbieri, Lavinia A; Hassan, Cesare; Rosati, Riccardo; Romario, Uberto Fumagalli; Correale, Loredana; Repici, Alessandro
• Is Part Of: United European Gastroenterology journal. Volume 3:Issue 4(2015:Aug.)
• Page Start: 325
• Page End: 334
• Publication Date: 2015-08
• Subjects: Achalasia -- adverse events -- complications -- endoscopic esphageal myotomy -- esophageal sphincter -- esophagus -- myotomy -- peristalsis -- review -- safety -- swallowing; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640615581732
• Languages: English
• ISSNs: 2050-6406

Abstract

Background: Peroral endoscopic esophageal myotomy (POEM) represents a less invasive alternative, as compared with conventional laparoscopic Heller myotomy for treating achalasia patients. In the last years, a number of prospective and retrospective experiences with POEM use for achalasia have been published. Methods: Relevant publications in which patients affected by achalasia underwent POEM treatment were identified by PubMed databases for the period 2010 – 2013. From each study, we extracted the number and type of major complications (defined as those requiring any additional medical or surgical intervention). Data were pooled, using random-effects models. Heterogeneity among studies was assessed by using Cochran's Q and the I 2 statistic. Results: We found 16 studies that provided data on 551 patients. The median surveillance period was 6 months (range: 3–12). The median of mean POEM duration was 156 minutes (range: 42–112). Median myotomy length was 10 cm (range: 6–14). Technical and clinical success were reported in 97% (95% CI: 94–98%) and 93% (407/428; 95% CI: 90–95%). No heterogeneity ( I 2 = 0%) or publication bias was present in both estimates. When limiting the analysis only to adverse events that require medical or surgical interventions, major adverse events occurred in 14% (95% CI: 11–17%); however, only one patient needed post-POEM surgery (0.2%; 95% CI: 0–0.5%). Conclusions: POEM appeared to be a highly feasible and effective endoscopic treatment for achalasia. Despite POEM being apparently associated with relatively high morbidity, most patients are successfully managed conservatively, so that POEM appears as a very safe procedure; however, POEM should only be performed in centers able to treat POEM complications, such as pneumothorax or pneumoperitoneum.