Original article Clinical endoscopy| Volume 97, ISSUE 4, P655-663.e2, April 2023

Prevalence and impact of opioid use in patients undergoing peroral endoscopic myotomy

Published:December 08, 2022DOI:

      Background and Aims

      Chronic narcotic use may cause opioid-induced esophageal dysfunction and associated type III achalasia, hypercontractile esophagus (HE), diffuse esophageal spasm (DES), and esophagogastric junction outflow obstruction (EGJOO). The frequency of opioid use and its impact on peroral endoscopic myotomy (POEM) in these patients is unknown.


      Consecutive patients between April 2017 and September 2021 who underwent POEM for type III achalasia, EGJOO, DES, or HE with ≥6 months follow-up were identified. Baseline evaluation was done with EGD, esophageal high-resolution manometry (HRM), and functional lumen impedance planimetry (FLIP) of the esophagogastric junction (EGJ). Eckardt scores (ESs) were calculated at baseline and follow-up at 6 to 12 months after POEM for opioid users and nonusers. Clinical response was defined as ES ≤3, EGJ distensibility index >2.8 mm2/mm Hg, maximum EGJ diameter >14 mm, and integrated relaxation pressure (IRP) <15 mm Hg. Opioid use before baseline HRM was assessed.


      One hundred twenty-six patients underwent POEM, and 89 had ≥6 months of follow-up. Daily opioid use was present in 18 of 89 patients (20%). Baseline demographics, FLIP metrics, IRP, distribution of motility disorders, and POEM characteristics were similar between both groups. At 6 to 12 months after POEM, clinical response and frequency of GERD, esophagitis, and proton pump inhibitor use were similar between opioid users and nonusers. Heartburn was more frequent in the opioid group (82.4% vs 38.6%, P = .002).


      In this single-center study of 89 patients with type III achalasia, EGJOO, DES, or HE treated with POEM, daily opioid use was present in 20%. Response to POEM and post-POEM GERD were similar between opioid users and nonusers. (Clinical trial registration number: NCT02770859.)


      DES (diffuse esophageal spasm), EGJ (esophagogastric junction), EGJ-DI (esophagogastric junction distensibility index), EGJOO (esophagogastric junction outflow obstruction), ES (Eckardt score), FLIP (functional lumen imaging probe), HE (hypercontractile esophagus), HRM (high-resolution manometry), IRP (integrated relaxation pressure), MME (morphine milligram equivalents), OIED (opioid-induced esophageal dysfunction), POEM (peroral endoscopic myotomy), PPI (proton pump inhibitor)
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