S2273 GERD Following POEM: Is Endoscopic Fundoplication the Answer? A Meta-Analysis

Introduction: Endoscopic fundoplication (EF) has emerged as a therapeutic option for gastroesophageal reflux disease (GERD), with well-established safety and efficacy. Techniques include transoral incisionless fundoplication (TIF) and endoscopic full-thickness fundoplication (EFTP). GERD is a common and well-documented adverse event following peroral endoscopic myotomy (POEM). While EF is supported by robust data in the general GERD population, its safety and efficacy in the post-POEM setting remain unclear. This study aims to conduct a meta-analysis evaluating the safety and efficacy of EF in managing GERD following POEM. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines to identify studies evaluating the safety and efficacy of EF after POEM. Keywords included: POEM, GERD, fundoplication, following, after, and postoperative. In the meta-analysis, a random-effects model was employed, and odds ratios (ORs) were calculated for dichotomous outcomes. Results: The initial search yielded 404 records, of which 381 were excluded as clearly irrelevant. The remaining 23 articles underwent full-text review, with 18 excluded for specific reasons: Studies evaluating TIF outcomes in the general population (n = 6), videos/case reports/reviews/editorials (n = 6), studies of concomitant POEM and EF (n = 2), POEM-only studies (n = 2), animal model studies (n = 1), and one study on antireflux ablation post-POEM (n = 1). A significant reduction in proton pump inhibitor (PPI) use was observed following EF (OR 0.05, 95% CI 0.01–0.40, P = 0.005; I² = 40%, P = 0.17). Subgroup analysis by technique (TIF vs EFTP) showed no significant differences (P = 0.12). EF was also associated with a significant reduction in esophagitis rates (OR 0.09, 95% CI 0.02–0.40, P = 0.001; I² = 0%, P = 0.81). The pooled adverse event rate was 11.9%, and the technical success rate was 100%. Conclusion: Current data on EF for GERD following POEM remain limited. Preliminary evidence suggests that EF is a safe and effective intervention in this setting. However, definitive conclusions cannot yet be drawn. Further studies with larger cohorts are warranted. In particular, randomized controlled trials comparing EF with surgical fundoplication post-POEM, as well as studies evaluating concomitant EF at the time of POEM, are needed to better define the optimal management strategy.