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.