the assessment of these variables should be independent from the POEM procedure, although all of the involved operators whom were not blinded to the procedure performed. See Appendix 1 and Appendix 3.
Discussion
According to our systematic review, POEM is a highly feasible, effective and safe procedure to treat achalasia. In a pooled population of 551 patients, we showed a technical feasibility of 97%. Moreover, in a subgroup of patients, we showed a 93% success rate, whilst the risk of adverse events requiring medical/surgical treatments was limited to 14% of the cases, resulting in surgery only in 0.2% of the initial population. Our results are relevant for the following reasons:
1. First, despite that any single study may appear underpowered to provide a reliable estimate of POEM efficacy, our pooled synthesis is associated with a limited 95% CI, showing a high degree of certainty on its precise estimate. 2. We did not detect any degree of heterogeneity in the efficacy estimate, showing the generalizability and reproducibility of the procedure. Of note, the