Repeat POEM works well against persistent achalasia symptoms

Patients with persistent symptoms of achalasia may benefit from repeat per-oral endoscopic myotomy (POEM) following a failed initial procedure, suggests a study.

The authors searched major databases from inception to April 2024 and identified studies that assessed the efficacy and safety of repeat POEM after a failed POEM in patients with achalasia. Outcomes of interest included clinical success (a reduction in the Eckardt score to ≤3), adverse events, and differences in pre- and post-procedure Eckardt scores.

The random effects model was used to calculate the pooled rates with 95 percent confidence intervals (CIs) for categorical variables and mean difference (MD) with 95 percent CIs for continuous variables.

Six observational studies, including a total of 123 patients, met the eligibility criteria. The mean time between myotomies ranged from 12.2 to 13.5 months.

The pooled rate of clinical success was high at 82.69 percent (95 percent CI, 69.65–93.06), while that of adverse events was relatively low at 17.97 percent (95 percent CI, 5.08–35.15). The pooled mean post-procedure Eckardt score was 1.63, which was significantly lower than that of the preprocedure score (MD, 3.68, 95 percent CI, 2.58–4.78).

“Repeated POEM is an effective option for persistent symptoms of achalasia after initial POEM,” the authors said. “[H]owever, it is associated with nontrivial adverse events.”