Research Article|Articles in Press

Comparing clinical success and procedural difficulty between treatment-naïve and treatment-refractory patients with esophageal motility disorders during per oral endoscopic myotomy

Published:February 03, 2023DOI:
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      Per Oral Endoscopic Myotomy (POEM) can successfully treat patients with achalasia. Prior therapy with Botox injections, pneumatic dilation (PD), and/or laparoscopic heller myotomy (LHM) is thought to increase the difficulty of POEM procedures. We aimed to determine if prior treatment methods were associated with longer procedure times or lower clinical success.


      Single center retrospective study of consecutive patients who underwent POEM for achalasia between February 2017 to September 2021. Data collected included patient demographics, prior treatment, pre- and post-procedure Eckardt score (ES), distensibility indices (DI), and procedure times. Primary outcomes were clinical success and procedure difficulty.


      A total of 95 patients (mean age 55.6 years, 45% female) underwent POEM for Type I achalasia (25), Type II achalasia (31), and spastic esophageal pathologies (33). 33 (34.7%) patients were treated for achalasia prior to the POEM with Botox injections (n=18), PD (n=17), and LHM (n=3). There was no significant difference in post-ES or technical success between these two groups (p=0.98 and p=0.66). Multivariate analysis showed that prior treatment was associated with decreased case time and easier tunneling during the POEM.


      Prior treatment did not impact POEM clinical success rate and led to decreased case times and easier tunneling difficulty, likely due to persistent LES changes and differences in diagnostic indications. POEM should be considered for patients with treatment-refractory symptoms as a safe and feasible option. Further large scale studies are needed to validate our findings.


      (POEM) (per oral endoscopic myotomy), (LES) (lower esophageal sphincter), (PD) (pneumatic dilation), (LHM) (laparoscopic heller myotomy), (FLIP) (functional lumen imaging probe, topography), (ES) (Eckardt score), (DI) (Distensibility Index), (TPL) (tunnel and myotomy time per length)
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