S2249 An Updated Systematic Review and Meta-Analysis Comparing Peroral Endoscopic Myotomy (POEM) and Pneumatic Balloon Dilatation (PD) for the Treatment of Achalasia

Introduction: Achalasia is a chronic esophageal motility disorder characterized by the failure of the lower esophageal sphincter (LES) to relax, leading to dysphagia, regurgitation, and weight loss. Peroral Endoscopic Myotomy (POEM) and Pneumatic Balloon Dilatation (PD) are 2 prominent therapeutic options for achalasia. This systematic review and meta-analysis aimed to compare the efficacy, safety, and clinical outcomes of POEM and PD. Methods: A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted from 2018 to 2024. Studies were included if they were peer-reviewed, compared POEM and PD, and reported key clinical outcomes. Data were extracted and analyzed using R software with meta and metafor packages. The primary outcomes were clinical success rates, changes in Eckardt score, and adverse events. Secondary outcomes included LES pressure reduction, length of hospital stay, and re-treatment rates. Results: Eleven studies involving 827 patients were included in the meta-analysis. POEM showed significantly higher success rates at 3, 6, 12, and 24 months (RR: 1.20, 1.15, 1.39, and 1.42, respectively; all P-values < 0.05). The mean difference in Eckardt score was -0.6923 (95% CI: -1.2840 to -0.1006, P = 0.0218), indicating better symptom relief with POEM. POEM also resulted in a greater reduction in LES pressure (MD: -4.1330, 95% CI: -6.7570 to -1.5090, P = 0.0020). However, POEM was associated with a higher incidence of gastroesophageal reflux disease (GERD) and other complications, although the difference in adverse events was not statistically significant (RR: 2.06, 95% CI: 0.76 to 5.59, P = 0.158). The need for re-treatment was significantly lower with POEM (RR: 0.23, 95% CI: 0.08 to 0.66, P = 0.00596). Conclusion: POEM is a more effective therapeutic option for achalasia compared to PD, offering superior clinical success rates, greater symptom relief, and a lower recurrence rate. However, POEM is associated with a higher risk of GERD and other complications. Despite these risks, POEM's long-term benefits make it the treatment of choice in most patients. Future research should focus on optimizing patient selection, reducing complications, and refining management strategies for achalasia.