Geisinger Wyoming Valley Medical Center Wilkes-Barre, PA
Umar Hayat, MD1, Saba Afroz, MD2, Adil Memon, MD3, Madeeha Sadiq, MD4, Muhammad Kamal, MD5, Muhammad Haseeb, MD6, Manesh Kumar Gangwani, MD7, Umer Farooq, MD8, Shamsa Akhtar, MD9, Yakub Khan, MD2, Faisal Kamal, MD10 1Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; 2Geisinger Wyoming Valley Hospital, Wilkes-Barre, PA; 3Louisiana State University, Shreveport, LA; 4East Tennessee State University, Johnson City, TN; 5Essen Health Care System, New York, NY; 6Brigham and Women's Hospital, Boston, MA; 7University of Toledo, Toledo, OH; 8University of Rochester, Rochester, NY; 9Jinnah Hospital Lahore, Lahore, Punjab, Pakistan; 10Thomas Jefferson Health, Philadephia, PA
Introduction: Achalasia is a typical esophageal motility disorder associated with halting symptoms that can herald a poor quality of life. Peroral endoscopic myotomy (POEM) has been considered a promising treatment modality for achalasia. Several studies have described the feasibility of POEM for achalasia among the elderly population. In this meta-analysis, we sought to evaluate POEM's therapeutic safety and efficacy among elderly patients with achalasia.
Methods: Major databases such as MEDLINE, Embase, Web of Science, CINAHL, and Cochrane Central registry were searched from the inception to April 2023 to find articles that compared the feasibility and safety of POEM for Achalasia between older people >75 years of age and young population < 75. Our primary outcomes of interest were the POEM's technical and clinical success rates. Technical success was defined as the successful completion of myotomy, and clinical success was defined as the Eckart score of ≤ 3 two months after POEM. The secondary outcome was the adverse events of the procedure. Pooled odds ratios with 95% confidence intervals (CI) for our outcomes of interest were calculated using a random effect model. We used I2 statistics to assess the heterogeneity. We did not assess publication bias as the number of studies was less than 10.
Results: Five studies with 328 patients >75 and 2369 < 75 were included. Pooled Technical success rate was 98.66% (92.45%, 100%) and 97.03% (91.63%, 98.98%) for the elderly and young, respectively. Similarly, the pooled clinical success was 94.74% (82.71%, 98.54%) and 94.94% (87.69%, 98.01%) for the elderly and young, respectively. There was no difference in the technical OR: 0.96 (CI: 0.81, 1.15, p = 0.69) and clinical success OR: 1.00 (CI: 0.85, 1.19, p = 0.98) POEM rates between the two groups. Also, the two groups had no difference in the adverse effects profile OR: 1.18 (CI: 0.46, 3.03, p = 0.73).
Discussion: Our study demonstrates the feasibility and safety of POEM for Achalasia among older people despite co-morbidities in this population. POEM is a highly safe and effective treatment modality for achalasia in this patient population. Prospective studies should be done to validate these findings further.
Figure: Pooled Odds Ratios of A) technical success, B) clinical success, and C) adverse events of POEM among the elderly and young population.
Disclosures:
Umar Hayat indicated no relevant financial relationships.
Saba Afroz indicated no relevant financial relationships.
Adil Memon indicated no relevant financial relationships.
Madeeha Sadiq indicated no relevant financial relationships.
Muhammad Kamal indicated no relevant financial relationships.
Muhammad Haseeb indicated no relevant financial relationships.
Manesh Kumar Gangwani indicated no relevant financial relationships.
Umer Farooq indicated no relevant financial relationships.
Shamsa Akhtar indicated no relevant financial relationships.
Yakub Khan indicated no relevant financial relationships.
Faisal Kamal indicated no relevant financial relationships.
Umar Hayat, MD1, Saba Afroz, MD2, Adil Memon, MD3, Madeeha Sadiq, MD4, Muhammad Kamal, MD5, Muhammad Haseeb, MD6, Manesh Kumar Gangwani, MD7, Umer Farooq, MD8, Shamsa Akhtar, MD9, Yakub Khan, MD2, Faisal Kamal, MD10. P1821 - Feasibility and Safety of Peroral Endoscopic Myotomy Among Elderly Patients With Achalasia: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
