Comprehensive evaluation of current strategies in achalasia treatment: Insights from an umbrella review

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BACKGROUND: Achalasia poses a considerable clinical challenge due to its complex pathophysiology and varied treatment responses. This umbrella review aims to consolidate current meta-analyses, providing a comprehensive evaluation of treatment efficacy across various methodologies. By employing statistical analyses and concise quality assessment, we seek to standardize outcomes and effectively highlight the limitations inherent in existing research. METHODS: A comprehensive literature search was conducted across 5 international databases, including PubMed, Scopus, Web of Science, Embase, and the Cochrane Library, to identify relevant meta-analyses focused on achalasia treatments. Key parameters evaluated included clinical success rates, complications, operation times, and lengths of hospital stay. Statistical synthesis was employed to compare treatment effectiveness across studies. RESULTS: The initial search identified 1037 records, of which 23 meta-analysis studies were included in this study. This review suggests that peroral endoscopic myotomy (POEM) may be comparable to, or potentially more effective than, Heller myotomy in the short-term management of achalasia. However, this was not further supported in longer follow-up durations. While POEM offers advantages such as shorter hospital stays, the ability to perform longer myotomies, and reduced operative duration, it demonstrated a greater risk of gastroesophageal reflux. However, the existing data are insufficiently conclusive, underscoring the need for additional long-term, high-quality studies to validate these results. CONCLUSION: This review highlights the comparable efficacy and safety of POEM and Heller myotomy in the treatment of achalasia. The variability in study quality and the presence of methodological flaws in the conducted studies underlines the need for further long-term research, improved methodological rigor, and standardized treatment protocols to optimize patient management in achalasia.

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