Role of Peroral Endoscopic Myotomy in Geriatric Patients with Achalasia: A Systematic Review and Meta-Analysis

Abstract

Background: Peroral endoscopic myotomy (POEM) is a particularly attractive intervention for achalasia. Presently, POEM has been reported to be effective and safe for achalasia in geriatric patients. Herein, this systematic review was conducted to explore the role of POEM in geriatric patients with achalasia. Method: PubMed, Embase and Cochrane Library were searched to identify studies evaluating the clinical outcome of POEM in geriatric patients with achalasia during January 2009 to October 2020. The primary outcomes were technical and clinical success. Secondary outcomes included postoperative Eckardt score, lower esophageal sphincter (LES) pressure, adverse events and clinical reflux. Results: There were seven studies with a total of 469 geriatric patients, pooled technical success of POEM treatment was 98.1% [95% confidence interval (CI), 95.1%-99.3%], and the pooled clinical success was 92.5% (95% CI, 89.3%-94.8%). After POEM, the Eckardt score significantly decreased by 6.09 points (95% CI, 5.44-6.74, P<0.00001), and the LES pressure significantly reduced by 13.53 mmHg (95% CI, 5.14-21.91, P=0.002). The pooled adverse events rate was 9.0% (95% CI, 4.3%-17.9%) and the post-POEM clinical reflux rate was 17.4% (95% CI, 12.9%-23.2%). Conclusions: Our current study demonstrated that POEM was an effective and safe technique for achalasia in geriatric patients.

Pneumatic Dilation in Geriatric Achalasia Patients

“…The 1-year remission rate for POEM was reported to be 93% in one study, 19 while the 3-year remission rate was reported to be 88.5% in another study. 20 In a recent meta-analysis by Zhong et al 5 regarding the role of POEM in geriatric achalasia patients, the clinical success of this treatment was reported to be 95.4% after 1 year and 92.8% after 3 years.…”

“…The treatment of achalasia in the geriatric age group is also still controversial. 5 Current treatment options for achalasia include medical treatment, botulinum toxin injection, endoscopic pneumatic dilation (PD), surgical laparoscopic Heller myotomy (LHM) + Dor fundoplication, and per-oral endoscopic myotomy (POEM). 5 - 7 Medical treatments have a low success rate, are administered to patients with advanced comorbidities and a low life expectancy, and have a limited response rate.…”

Research hotspots and trend of a emerging novel endoscopic technique of peroral endoscopic myotomy from 2010 to 2022: A bibliometric analysis

“…[23,24] In addition, a comparison of the efficacy of various operation methods of POEM has gradually emerged, such as anterior versus posterior direction anterior versus posterior myotomy [25] and short versus standard esophageal myotomy. [26] At the same time, studies on the efficacy of POEM in the treatment of special populations such as the pediatric, [27] the geriatric, [28] the failed Heller myotomy patients, [29] and other esophageal motility disorders patients [30] are also gradually emerging. Recently, the efficacy of the derivative technology of POEM, such as D-POEM for esophageal diverticulum, [31] Z-POEM for Zenker diverticulum, [19] and G-POEM for refractory gastroparesis [20] has gradually become a hot topic.…”

Clinical Outcomes and Complications for Achalasia Patients Admitted After Per-Oral Endoscopic Myotomy

“…Literature reports that the mean age for patients with achalasia that undergo POEMs may range from 34 to 59 years, with a median age of approximately 51 years [ 20 , 21 ]. The procedure has been established to be highly effective and safe in the elderly demographic, thereby increasing its utilization in the subset population [ 22 , 23 ].…”