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Barbieri LA, Hassan C, Rosati R, et al. Systematic review and meta-analysis: Efficacy and safety of POEM for achalasia. United European Gastroenterol J. 2015;3(4):325-34doi: 10.1177/2050640615581732.
Barbieri, L. A., Hassan, C., Rosati, R., Romario, U. F., Correale, L., & Repici, A. (2015). Systematic review and meta-analysis: Efficacy and safety of POEM for achalasia. United European gastroenterology journal, 3(4), 325-34. https://doi.org/10.1177/2050640615581732
Barbieri, Lavinia A, et al. "Systematic review and meta-analysis: Efficacy and safety of POEM for achalasia." United European gastroenterology journal vol. 3,4 (2015): 325-34. doi: https://doi.org/10.1177/2050640615581732
Barbieri LA, Hassan C, Rosati R, Romario UF, Correale L, Repici A. Systematic review and meta-analysis: Efficacy and safety of POEM for achalasia. United European Gastroenterol J. 2015 Aug;3(4):325-34. doi: 10.1177/2050640615581732. PMID: 26279840; PMCID: PMC4528214.
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United European Gastroenterol J. 2015 Aug;3(4):325-34. doi: 10.1177/2050640615581732.

Systematic review and meta-analysis: Efficacy and safety of POEM for achalasia.

United European gastroenterology journal

Lavinia A Barbieri, Cesare Hassan, Riccardo Rosati, Uberto Fumagalli Romario, Loredana Correale, Alessandro Repici

Affiliations

  1. Endoscopy Unit and Department of Surgery, Istituto Clinico Humanitas, Milan, Italy.

PMID: 26279840 PMCID: PMC4528214 DOI: 10.1177/2050640615581732

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.

Keywords: Achalasia; adverse events; complications; endoscopic esphageal myotomy; esophageal sphincter; esophagus; myotomy; peristalsis; review; safety; swallowing

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