Surgical endoscopy · 2026
POEM vs laparoscopic Heller myotomy with fundoplication for achalasia: systematic review and meta-analysis of randomized and prospective studies.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Mirza Wajahat, Badshah Maaz Bin, Khan Mehak Ejaz, Iqbal Hania, Khan Alishbah, Moeen-Ud-Din Muhammad Bilal
Аннотация
BACKGROUND: Achalasia is definitively treated with peroral endoscopic myotomy (POEM) or laparoscopic Heller myotomy with fundoplication (LHM + PF), but reflux after POEM remains a key concern. We compared the safety and GERD outcomes of POEM and LHM + PF using randomized controlled trials and prospective comparative studies in treatment-naïve adults.
METHODS: We searched the MEDLINE, Embase, CENTRAL, Web of Science, and Scopus databases on October 18, 2025. Eligible studies directly compared POEM and LHM + PF in adults. The primary outcome was adverse events, and the secondary outcomes were endoscopic reflux esophagitis, abnormal 24-h pH, procedure time, and length of hospital stay. Random-effects meta-analyses were used to generate risk ratios (RRs) and mean differences (MDs). Certainty was graded using the GRADE system, and sensitivity and subgroup analyses were performed.
RESULTS: Four studies (three RCTs and one propensity-matched cohort; n = 590) met the inclusion criteria. Adverse events were similar (RR 1.15, 95% CI 0.38-3.44). POEM was associated with higher rates of endoscopic esophagitis (RR 3.10, 95% CI 2.17-4.41) and abnormal pH (RR 1.94, 95% CI 1.07-3.53) compared to LHM + PF. Procedure time did not differ significantly between groups (MD = - 62.05 min, 95% CI - 180.78 to 56.67) with wide confidence intervals indicating imprecision. The length of hospital stay was comparable (MD = 0.32 days, 95% CI - 0.21 to 0.85).
CONCLUSION: In treatment-naïve adults, POEM and LHM + PF had comparable safety profiles and hospital stays. POEM is associated with higher reflux rates than LHM + PF. Both are viable options, and the selection should be individualized based on the patient's phenotype and institutional expertise.
METHODS: We searched the MEDLINE, Embase, CENTRAL, Web of Science, and Scopus databases on October 18, 2025. Eligible studies directly compared POEM and LHM + PF in adults. The primary outcome was adverse events, and the secondary outcomes were endoscopic reflux esophagitis, abnormal 24-h pH, procedure time, and length of hospital stay. Random-effects meta-analyses were used to generate risk ratios (RRs) and mean differences (MDs). Certainty was graded using the GRADE system, and sensitivity and subgroup analyses were performed.
RESULTS: Four studies (three RCTs and one propensity-matched cohort; n = 590) met the inclusion criteria. Adverse events were similar (RR 1.15, 95% CI 0.38-3.44). POEM was associated with higher rates of endoscopic esophagitis (RR 3.10, 95% CI 2.17-4.41) and abnormal pH (RR 1.94, 95% CI 1.07-3.53) compared to LHM + PF. Procedure time did not differ significantly between groups (MD = - 62.05 min, 95% CI - 180.78 to 56.67) with wide confidence intervals indicating imprecision. The length of hospital stay was comparable (MD = 0.32 days, 95% CI - 0.21 to 0.85).
CONCLUSION: In treatment-naïve adults, POEM and LHM + PF had comparable safety profiles and hospital stays. POEM is associated with higher reflux rates than LHM + PF. Both are viable options, and the selection should be individualized based on the patient's phenotype and institutional expertise.