Is Peroral Esophageal Myotomy (POEM) Comparable to Laparoscopic Hellerʼs Myotomy for Achalasia?: A Systematic Review and Meta-analysis of the Current Literature

Abstract

Introduction: Achalasia is a neuromuscular disorder with significant morbidity leading to more recent focus on advancing current treatment options. Per-oral endoscopic myotomy (POEM) is gaining attention among interventional gastroenterologists and gastrointestinal surgeons since 2010. Recent literature comparing POEM with laparoscopic Heller myotomy (LHM) for achalasia has been heterogeneous secondary to lower sample size and /or lack of randomized trials. The purpose of this meta-analysis was to assess the safety and efficacy between POEM and LHM. Methods: Literature were identified by searching the electronic databases of PubMed, the Cochrane Database of Systematic Reviews and gray literature from inception to May 25, 2015. For quality assurance purposes throughout the systematic review, multiple independent extractions were performed and the process was executed as per the standards of the Cochrane collaboration. Primary outcomes were operative time, mean change in Eckardt score. Secondary outcomes included days hospitalized and adverse events. Cochrane risk of bias tool was used to assess the methodological quality of included studies. All data were pooled under a random effects model. Overall quality of evidence was summarized using the GRADE method.The data were analyzed using Review Manager version 5.1 software. Results: Overall, six studies were identified that compared outcomes between LHM and POEM for a total of 468 patients. The LHM procedure appeared to have a longer operative time, in minutes, (MD=46.99, 95% CI: -7.93-101.92; p=0.09), but was not statistically significant. There was also no significant difference in the mean change in Eckardt Score (MD=0.33, 95% CI: -0.65-1.31; p=0.51), length of hospital stay, in days, (MD= -0.24, 95% CI: -1.43-0.95; p=0.69), or occurrence of any adverse event (OR=1.24, 95% CI: 0.39-3.89; p=0.72) between LHM and POEM. Conclusion: Based on limited literature, our meta-analysis shows POEM is a comparable intervention for achalasia treatment compared to LHM. However, future large randomized controlled trials with large sample size are warranted to verify these findings.