Peroral endoscopic myotomy with fundoplication (POEM-F) for achalasia: Systematic review and meta-analysis

• Published in: Endoscopy International Open Vol. 13; no. CP; p. a25368132
• Main Authors: Gopakumar, Harishankar, Annor, Eugene, Vohra, Ishaan, Andalib, Iman, Tyberg, Amy, Sarkar, Avik, Shahid, Haroon, Carames, Mine, Carames, Juan Carlos, Gularte, Giovanna Porfilio, Al-Lehibi, Abed, Alkhiari, Resheed, Bapaye, Amol, Robles-Medranda, Carlos, Kahaleh, Michel
• Format: Journal Article
• Language: English
• Published: Germany Georg Thieme Verlag KG 2025
• Subjects: Barrett's and adenocarcinoma; Endoscopy Upper GI Tract; Motility / achalasia; Original article; Reflux disease; Barrett's and adenocarcinoma; Reflux disease; Endoscopy Upper GI Tract; POEM; Motility / achalasia
• DOI: 10.1055/a-2536-8132
• ISSN: 2364-3722

Gastroesophageal reflux (GER) and its long-term sequelae remain a concern following peroral endoscopic myotomy (POEM). POEM with fundoplication (POEM-F) is simultaneous fundoplication via pure natural orifice transluminal endoscopic surgery (NOTES). In this study, we evaluated the efficacy and safety of POEM-F in mitigating post-POEM GER. We performed a comprehensive electronic database search from January 2008 through June 2024 for studies evaluating outcomes of POEM-F performed for managing post-POEM GER. Pooled proportions were calculated using random-effects models. Heterogeneity was assessed using I2 and Q statistics. We included seven studies comprising 127 patients. Pooled technical success for POEM was 96.90%; 95% confidence interval [CI] 91.40–98.90. Pooled technical success of fundoplication was 92.30%; 95% CI 85.20–96.10. Clinical success in treating achalasia was 96.40%; 95% CI 90.70–98.60. Rate of wrap integrity on follow-up was 84.00%; 95% CI 66.00–93.40. Composite clinical success of POEM-F in mitigating post-POEM GER was 86.20%; 95% CI 73.80–93.20. Mean total procedure duration and fundoplication time was 115.74 minutes; 95% CI 103.53–126.96 and 55.28 minutes; 95% CI 47.35–63.20, respectively. The overall pooled major adverse events (AE) rate was 3.60%; 95% CI 1.40–9.40. POEM-F is an effective procedure with an acceptable AE rate in expert hands. It appears to offer clinical benefit in mitigating post-POEM GER. However, further standardization for evaluating clinically significant post-POEM GER and long-term benefit of POEM-F is warranted.