Efficacy and Safety of Peroral Endoscopic Myotomy (POEM) for Achalasia in Post-Bariatric Surgery Patients: A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is an emerging process that turned out to be a highly favored minimally invasive technique for achalasia treatment even in the presence of anatomical alteration as in bariatric surgery. POEM applications on bariatric patients showed promising results in the term of technical success and symptom improvement. We evaluated the available evidence regarding the effectiveness and safety of POEM therapy for patients with achalasia who have previously undergone bariatric surgery. METHODS: We followed the PRISMA guidelines for meta-analysis. We included studies reporting on bariatric patients with achalasia who underwent POEM. Our primary outcomes were technical Success, clinical Success, post-POEM Eckardt Score, Eckardt Score Change, and complications such as post-procedure leak and intra-procedural bleeding. We used the Joanna Briggs Institute's (JBI) Critical Appraisal Tool for quality assessment. RESULTS: Twelve studies were included in this review. The mean Eckardt Score Change was -5.09 (95%CI: -6.05 to -3.67). The clinical and technical success were 95% (95%CI: 0.88-1.00) and 99% (95%CI: 0.93-1.00). The total adverse events rate was 5% (95%CI: 0-0.12). The pooled proportion for postprocedural leak was 2% (95%CI: 0-0.10). The mortality rate was 0% (95% CI: 0-0.06). CONCLUSIONS: Our systematic review and meta-analysis demonstrated that POEM seems to be an effective and safe treatment for achalasia in patients with prior bariatric surgery. Further prospective studies with standardized protocols and longer follow-up are needed to support our initial findings, refine patient selection, optimize technique, and establish the long-term durability of outcomes.