Is Single-Session Peroral Endoscopic Myotomy With Fundoplication Safe and Effective in Achalasia? A Systematic Review and Meta-Analysis.

Background: Peroral endoscopic myotomy (POEM) is a minimally invasive treatment for achalasia but is often associated with gastroesophageal reflux disease (GERD). Adding fundoplication (POEM+F) may reduce reflux while maintaining the benefits of myotomy. This systematic review and meta-analysis evaluate the efficacy and safety of POEM+F in achalasia patients. Methods: A comprehensive search of electronic databases and conference proceedings was conducted through November 2024 to identify studies on POEM+F. Pooled proportions were calculated using both fixed effects models. Heterogeneity was assessed via Cochran's Q test. Primary outcomes included technical success, Eckardt score improvement, and post-procedure esophagitis. Secondary outcomes included procedure time, adverse events, wrap integrity, and hospital stay. Results: Nine studies with 202 patients were included. The pooled technical success rate was 94.80% (95% confidence interval [CI]: 91.37-97.40). Mean total procedure time was 110.51 min, with 52.04 min for fundoplication. Eckardt scores improved from 8.30 (95% CI: 6.83-9.76) pre-operatively to 1.08 (95% CI: 0.33-2.50) post-operatively. Post-procedure, 11.52% (95% CI: 6.10-18.38) had abnormal acid exposure and 20.65% (95% CI: 14.47-27.61) developed esophagitis. An intact wrap was seen in 75.69% (95% CI: 58.55-89.40) on follow-up endoscopy. Mean hospital stay was 2.27 days (95% CI: 1.09-3.45). Conclusions: POEM with fundoplication is a safe and effective treatment for achalasia, offering high technical success, symptom relief, and a low incidence of GERD.