Peroral Endoscopic Myotomy for Achalasia Among the Elderly Population: A Systematic Review and Meta-Analysis

Achalasia is an esophageal motility disorder associated with halting symptoms. There is conflicting evidence about the feasibility of peroral endoscopic myotomy (POEM) for achalasia among the elderly. In this meta-analysis, we sought to evaluate POEM's therapeutic safety and efficacy among elderly patients with achalasia.

Major databases were searched to find articles that compared the feasibility and safety of POEM for Achalasia between 4 age groups in 2 separate comparisons: ≥75 and <75 years, and ≥65 and <65 years. Our primary outcomes of interest were to compare POEM's technical and clinical success rates. The secondary outcome was the adverse events of the procedure. A random effect model calculated pooled odds ratios with 95% CIs.

Six studies were included with 290 patients ≥75 years of age and 2290 <75, 177 ≥65, and 354 younger than 65. The pooled technical success rate was 98.66% and 97.81% for patients ≥75 years of age and younger than 75, respectively. Similarly, the pooled clinical success rate was 99.01% and 97.97% for ≥75 and younger than 75, respectively. The pooled technical success rate was 99.69% and 99.84% for ≥65 and younger than 65, respectively. Similarly, the pooled clinical success rate was 95.74% and 95.31% for ≥65 and younger than 65, respectively. There was no difference in the technical and clinical success rates in both comparison groups. Also, the 2 groups had no difference in the adverse events profile of the 2 comparison groups.

Our study demonstrates the feasibility and safety of POEM for achalasia among older people despite their comorbidities.