Peroral Endoscopic Myotomy (POEM) Vs Pneumatic Dilation (PD) in Treatment of Achalasia: A Meta-analysis of Studies with ≥ 12-month Follow-up

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). 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). 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 %  = 0.001; 90.6 % vs 74.8 %,  = 0.004; 88.4 % vs 72.2 %,  = 0.006, respectively). POEM was superior to PD in type I, II and III achalasia (92.7 % vs 61 %,  = 0.01; 92.3 % vs 80.3 %,  = 0.01; 92.3 %v 41.9 %,  = 0.01 respectively) Pooled OR of clinical success at 12 and 24 months were significantly higher with POEM (8.97;  = 0.001 & 5.64;  = 0.006). Pooled OR of GERD was significantly higher with POEM (by symptoms: 2.95,  = 0.02 and by endoscopic findings: 6.98,  = 0.001). Rates of esophageal perforation (0.3 % vs 0.6 %,  = 0.8) and significant bleeding (0.4 % vs 0.7 %,  = 0.56) were comparable between POEM and PD groups. POEM is more efficacious than PD in the treatment of patients with achalasia during short-term and long-term follow-up, albeit with higher risk of abnormal esophageal acid exposure.