P3540 - An Updated Systematic Review and Meta-Analysis Comparing Peroral Endoscopic Myotomy (POEM) and Pneumatic Balloon Dilatation (PD) for the Treatment of Achalasia

Hasan Al-Obaidi, MD¹, Nooraldin Merza, MD¹, Osamah Muslim, MD², Omar Saab, MD³, Amy Mackenzie, MD⁴, Mustafa Al-Obaidi, MD⁵, Hayder Alamily, MD⁶, Sana Rabeeah, MD⁷, Mohannad Bitar, MD⁸, Mushfiqur Siddique, MD⁸, Yusuf Nawras, BSc¹, Bisher Sawaf, MD⁹, Pratiksha Moliya, MD¹⁰, Mohammed Alani, MD¹¹, Fatima A. Merza, BS¹², Bilind Ismail, MD¹³, Eunice Kwak, MD¹⁴, Patel Manthanbhai, MD¹, Abdallah Kobeissy, MD, MPH⁷
1University of Toledo College of Medicine and Life Sciences, Toledo, OH; 2Al-Qadisiyah University College of medicine, Diwaniyah, Al Qadisiyah, Iraq; 3Banner - University of Arizona Tucson, Houston, TX; 4HCA Florida Orange Park Hospital, Orange Park, FL; 5Hassleholm hospital, Malmo, Skane Lan, Sweden; 6University of Colorado Anschutz Medical Campus, Denver, CO; 7The University of Toledo, Toledo, OH; 8Jamaica Hospital Medical Center, Jamaica, NY; 9University of Toledo Medical Center, Toledo, OH; 10University of Nebraska Medical Center, Omaha, NE; 11Midwestern University, Goodyear, AZ; 12University of Michigan-Dearborn, Canton, MI; 13Willis Knighton Health, Shreveport, LA; 14University of Toledo Health Sciences Campus, Toledo, OH

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 two 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).

Discussion: 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.


Figure: Figure 1: Success Rates Over Time (Forest Plot) A: Success rate at 3 months, B: Success rate at 6 months, C: Success rate at 12 months, D: Success rate at 24 months


Figure: Figure 2: Risk of Bias Assessment for Included Studies (Traffic Light Plot and Summary Plot)

Disclosures:
Hasan Al-Obaidi indicated no relevant financial relationships.
Nooraldin Merza indicated no relevant financial relationships.
Osamah Muslim indicated no relevant financial relationships.
Omar Saab indicated no relevant financial relationships.
Amy Mackenzie indicated no relevant financial relationships.
Mustafa Al-Obaidi indicated no relevant financial relationships.
Hayder Alamily indicated no relevant financial relationships.
Sana Rabeeah indicated no relevant financial relationships.
Mohannad Bitar indicated no relevant financial relationships.
Mushfiqur Siddique indicated no relevant financial relationships.
Yusuf Nawras indicated no relevant financial relationships.
Bisher Sawaf indicated no relevant financial relationships.
Pratiksha Moliya indicated no relevant financial relationships.
Mohammed Alani indicated no relevant financial relationships.
Fatima Merza indicated no relevant financial relationships.
Bilind Ismail indicated no relevant financial relationships.
Eunice Kwak indicated no relevant financial relationships.
Patel Manthanbhai indicated no relevant financial relationships.
Abdallah Kobeissy indicated no relevant financial relationships.

Hasan Al-Obaidi, MD¹, Nooraldin Merza, MD¹, Osamah Muslim, MD², Omar Saab, MD³, Amy Mackenzie, MD⁴, Mustafa Al-Obaidi, MD⁵, Hayder Alamily, MD⁶, Sana Rabeeah, MD⁷, Mohannad Bitar, MD⁸, Mushfiqur Siddique, MD⁸, Yusuf Nawras, BSc¹, Bisher Sawaf, MD⁹, Pratiksha Moliya, MD¹⁰, Mohammed Alani, MD¹¹, Fatima A. Merza, BS¹², Bilind Ismail, MD¹³, Eunice Kwak, MD¹⁴, Patel Manthanbhai, MD¹, Abdallah Kobeissy, MD, MPH⁷. P3540 - An Updated Systematic Review and Meta-Analysis Comparing Peroral Endoscopic Myotomy (POEM) and Pneumatic Balloon Dilatation (PD) for the Treatment of Achalasia, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.