Peroral endoscopic myotomy safe, effective for achalasia with sigmoid oesophagus

Treatment with peroral endoscopic myotomy (POEM) is safe and highly effective for advanced achalasia patients with sigmoid oesophagus comparable to those without sigmoid oesophagus in a Western population, suggests a recent study.

“In advanced achalasia patients with sigmoid oesophagus, POEM might be technically challenging, and its outcomes are not well known in Western population,” the authors said. “Hence, [we sought] to assess and compare the safety and efficacy of POEM in achalasia patients with and without sigmoid oesophagus.”

In this study, they reviewed the medical records of achalasia patients who had POEM between April 2014 and December 2019. The final analysis included those who underwent work-up comprising timed barium oesophagram (TBO) and high-resolution oesophageal manometry (HROM) before POEM along with a 2-month post-POEM oesophageal pH study, TBO, and HROM.

Of the 168 patients included, 20 had sigmoid oesophagus and 148 had none. The sigmoid oesophagus group had markedly greater oesophageal width on TBO at 1 minute than that in the no sigmoid oesophagus group (4.9 vs 3.0 cm; p<0.001). Procedural outcomes and complications were comparable between the two groups.

Both groups demonstrated significant improvements in Eckardt scores, TBO, and HROM parameters at 2-month follow-up. In addition, treatment success was high and similar in the two cohorts (94.4 percent vs 93.2 percent; p=0.84), as were the rates of gastro-oesophageal reflux disease.

“POEM should be considered as the treatment of choice in advanced achalasia with sigmoid oesophagus,” the authors said.