Peroral endoscopic myotomy (poem) vs pneumatic dilation (pd) in treatment of Achalasia: A meta-analysis of studies with ≥ 12-month follow-up

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).