Peroral endoscopic myotomy offers long-term benefits in jackhammer esophagus

Treatment with peroral endoscopic myotomy (POEM) demonstrates long-term efficacy in patients with jackhammer esophagus (JE), a rare hypercontractile motility disorder often associated with dysphagia, regurgitation, and chest pain, reports a study.

“In patients with clinically relevant symptoms, treatment options aim to decrease esophageal contractions. Medical, endoscopic, and surgical therapies have limited long-term efficacy. The advent of peroral endoscopic myotomy (POEM) has evolved as a minimally invasive treatment option,” the authors said.

A single-centre retrospective study was conducted among consecutive adult patients undergoing POEM for JE from April 2018 to September 2021. A single endoscopist performed all the procedures. Clinical success, defined as Eckardt score (ES) ≤3 following the procedure, was the primary outcome.

Thirteen patients (mean age 58 years, seven females) had received treatment with POEM, with a mean symptoms duration of 42.6 months. Preprocedure mean ES was 8.92. Of the patients, nine were treatment-naïve. The distensibility index of pre-POEM endoluminal functional luminal imaging probe (n=10) was 0.34, and the mean length of follow-up after POEM was 15.8 months.

Twelve patients (92.3 percent) achieved clinical success, with a mean post-POEM ES of 1.53. One patient had an improved ES from 12 to 1 following POEM, but she later developed recurrent symptoms (ES 10) after 2.5 years. Another patient had endoscopic evidence of Los Angeles grade A esophagitis.

In addition, five patients experienced gastroesophageal reflux disease symptoms 1 year after POEM, but only two needed acid suppression therapy.

“Larger, prospective studies are needed to validate these findings,” the authors said.