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

doi:10.4253/wjge.v16.i10.566

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World Journal of Gastrointestinal Endoscopy

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Meta-Analysis

World J Gastrointest Endosc. Oct 16, 2024; 16(10): 566-580
Published online Oct 16, 2024. 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, Shu Huang, Chun-Yu Zhong, Xia Wang, Su-Fen Fu, Ying-Qin Lv, Kang Zou, Mu-Han Lü, Yan Peng, Xiao-Wei Tang

Xin-Xin Pu, Xia Wang, Su-Fen Fu, Department of Gastroenterology, Dechang People’s Hospital of Sichuan Province, Liangshan 615500, Sichuan Province, China

Xin-Xin Pu, Ying-Qin Lv, Kang Zou, Mu-Han Lü, Yan Peng, Xiao-Wei Tang, Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China

Shu Huang, Department of Gastroenterology, Lianshui People’s Hospital of Kangda College Affiliated to Nanjing Medical University, Huaian 223499, Jiangsu Province, China

Chun-Yu Zhong, Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China

Co-first authors: Xin-Xin Pu and Shu Huang.

Author contributions: Tang XW and Pu XX contributed to study conception and design; Pu XX, Huang S and Zhong CY contributed to drafting of the manuscript; Wang X, Fu SF, Lv YQ, Zou K, Lü MH contributed to acquisition of data and critical revision; Tang XW and Peng Y contributed to revision of the manuscript, and final approval of the manuscript; All authors have read and approved the final manuscript.

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

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Xiao-Wei Tang, MD, PhD, Associate Professor, Postdoc, Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang Region, Luzhou 646000, Sichuan Province, China. solitude5834@hotmail.com

Received: May 24, 2024
Revised: August 17, 2024
Accepted: September 14, 2024
Published online: October 16, 2024
Processing time: 144 Days and 2.7 Hours

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; Peroral endoscopic myotomy; Pediatric; Geriatric; Meta-analysis

Core Tip: Peroral endoscopic myotomy (POEM), a minimally invasive procedure, has gained substantial acceptance as a treatment for achalasia due to its excellent safety profile, durability, and efficacy in adults. We conducted this systematic review and meta-analysis to summarize the durability, safety, and efficacy of POEM for treating achalasia in pediatric and geriatric patients. Our results indicated that POEM was an effective and safe technique for pediatric and geriatric patients with achalasia.