Per-oral endoscopic myotomy safe, effective in spastic oesophageal motility disorders

A recent study has demonstrated the safety, durability, and effectiveness of per-oral endoscopic myotomy (POEM) for the treatment of spastic oesophageal motility disorders (SEMD). Gastro-oesophageal reflux disease (GERD), however, has been observed in nearly half of patients requiring close monitoring following POEM.

SEMD is a rare group of motility disorders, which include type III achalasia, distal oesophageal spasm (DES), and Jackhammer oesophagus (JHE), according to the investigators.

A retrospective analysis was conducted using data of SEMD patients who underwent POEM from January 2013 to December 2019. The investigators recorded the following outcomes: POEM procedure details, technical and clinical success, adverse events, and GERD. Clinical success was classified as immediate (<1 year), short term (1–3 years), medium term (3– 5 years), and long term (>5 years).

During the study period, a total of 1,115 POEM procedures were carried out for achalasia and nonachalasia spastic motility disorders. POEM was performed in 74 patients (6.6 percent), including type III in 53, DES in 11, and JHE in 10 patients. All patients achieved technical success.

Median follow-up was 47.5 months (range, 2–77 months). Clinical success at short- and long-term follow-up was achieved in 85.2 percent and 82.6 percent of patients, respectively. No significant difference in clinical success was noted between type III achalasia and DES/JHE.

Twenty-one patients (28.4 percent) experienced mild and moderate adverse events. GERD was diagnosed in 23 patients (56.1 percent) with 24-hour pH study, while erosive oesophagitis and symptomatic GERD were detected in 36 (48.6 percent) and 16 (21.6 percent) patients, respectively.