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. 2024 Oct 16;16(10):566-580.
doi: 10.4253/wjge.v16.i10.566.

Safety and efficacy of peroral endoscopic myotomy for treating achalasia in pediatric and geriatric patients: A meta-analysis

Xin-Xin Pu  1   2 , Shu Huang  3 , Chun-Yu Zhong  4 , Xia Wang  1 , Su-Fen Fu  1 , Ying-Qin Lv  2 , Kang Zou  2 , Mu-Han Lü  2 , Yan Peng  2 , Xiao-Wei Tang  5
Affiliations

Safety and efficacy of peroral endoscopic myotomy for treating achalasia in pediatric and geriatric patients: A meta-analysis

Xin-Xin Pu et al. World J Gastrointest Endosc. .

Abstract

Background: As a less invasive technique, peroral endoscopic myotomy (POEM) has recently been widely accepted for treating achalasia with an excellent safety profile, durability, and efficacy in adults. In pediatric and geriatric patients, the treatment is more difficult.

Aim: To discuss the clinical outcomes of POEM in pediatric and geriatric patients with achalasia.

Methods: We conducted a comprehensive search of PubMed, Embase and Cochrane Library databases from inception to July 2024. The primary outcomes were technical and clinical success. Secondary outcomes of interest included adverse events and gastroesophageal reflux disease (GERD). The pooled event rates were calculated by comprehensive meta-analysis software.

Results: A total of 32 studies with 547 pediatric patients and 810 geriatric patients were included in this study. The pooled event rates of technical success, clinical success, GERD and adverse events of POEM for treating achalasia in pediatric patients were 97.1% [95% confidence interval (CI): 95.0%-98.3%; I² = 0%; P < 0.000], 93.2% (95%CI: 90.5%-95.2%; I² = 0%; P < 0.000), 22.3% (95%CI: 18.4%-26.7%; I² = 43.874%; P < 0.000) and 20.4% (95%CI: 16.6%-24.8%; I² = 67.217%; P < 0.000), respectively. Furthermore, in geriatric patients, the pooled event rates were 97.7% (95%CI: 95.8%-98.7%; I² = 15.200%; P < 0.000), 93.2% (95%CI: 90.3%-95.2%; I² = 0%; P < 0.000), 23.9% (95%CI: 19.4%-29.1%; I² = 75.697%; P < 0.000) and 10.8% (95%CI: 8.3%-14.0%; I² = 62.938%; P < 0.000], respectively.

Conclusion: Our findings demonstrated that POEM was an effective and safe technique for pediatric and geriatric patients with achalasia.

Keywords: Achalasia; Geriatric; Meta-analysis; Pediatric; Peroral endoscopic myotomy.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram showing study selection. POEM: Peroral endoscopic myotomy.
Figure 2
Figure 2
Forest plot of peroral endoscopic myotomy for achalasia in pediatric patients. A: Technical success; B: Clinical success; C: Gastroesophageal reflux disease; D: Adverse events. GERD: Gastroesophageal reflux disease.
Figure 3
Figure 3
Forest plot of peroral endoscopic myotomy for achalasia in geriatric patients. A: Technical success; B: Clinical success; C: Gastroesophageal reflux disease; D: Adverse events. GERD: Gastroesophageal reflux disease.
Figure 4
Figure 4
Assessment of publication bias in pediatric patients. A: Technical success; B: Clinical success; C: Gastroesophageal reflux disease; D: Adverse events.
Figure 5
Figure 5
Assessment of publication bias in geriatric patients. A: Technical success; B: Clinical success; C: Gastroesophageal reflux disease; D: Adverse events.
See this image and copyright information in PMC

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