Mohamed Barakat, MD1, Khalil Aloreidi, MD1, Ali Aamar, MD1, Evangelos Tsipotis, MD1, Eduardo Quintero, MD1, Mohamed Magdy Abdelfatah, MD2
1The Brooklyn Hospital Center, Brooklyn, NY; 2Emory University School of Medicine, Atlanta, GA
Introduction:Per-oral endoscopic myotomy (POEM) has promising safety and efficacy outcomes in short-term studies. However, long-term follow-up data are limited. The aims of this study was to review and analyze the clinical outcomes and failure rates of of studies that reported a minimum post-POEM follow-up of 3, 4 and 5 years.
Methods:A systematic review of POEM performed for the treatment of achalasia was performed. We searched major medical databases (Pubmed, Medline, Ovid, Cochrane and EBSCO databases) from inception till May 2019. Major conference abstracts and presentations were searched. Statistical analysis was performed using Med Calc Software (Ostend, Belgium). Clinical success was defined as Eckardt score ≤ 3 and failure was defined as Eckardt score >3 on follow up.
Results: A total of 8 retrospective and prospective studies fulfilled inclusion criteria (Table 1). The studies originated from China, Czech Republic, Japan and USA. The total number of patients included in this study was 671. Eight studies (671 patients) with follow up data post-POEM of a minimum of 3 years were included in the 3 year analysis. Four studies (407 patients) with 4 year follow up data post-POEM were included in the 4 year analysis. Three studies (97 patients) with 5 year follow up data post-POEM were included in the 5 year analysis. There was no heterogeneity between studies. The overall clinical success rate at the 3, 4 and 5 year follow up was 88% (95% CI 85-91%), 87% (95% CI 83-90%), 84% (95% CI 76-90%) respectively (Figure 1). The overall failure rates at 3, 4 and 5 year follow up were 11.7% (95% CI 9-15%), 13% (95% CI 10-17%) and 16% (95% CI 10-24%) respectively. There was no significant difference in clinical success or failure rates.
Discussion: Our study demonstrates that POEM is effective and safe for treating achalasia during the long term follow up to 5 years. Randomized controlled trials are needed to validate these findings.
Citation: Mohamed Barakat, MD; Khalil Aloreidi, MD; Ali Aamar, MD; Evangelos Tsipotis, MD; Eduardo Quintero, MD; Mohamed Magdy Abdelfatah, MD. P2082 - LONG-TERM OUTCOMES OF POEM IN ACHALASIA WITH A MINIMUM FOLLOW-UP OF 3, 4, AND 5 YEARS: A META-ANALYSIS. Program No. P2082. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.