Short-term Outcome of Peroral Endoscopic Myotomy Performed by the Same Endoscopist on Achalasia and Nonachalasia Esophageal Motility Disorders.

Abstract

BACKGROUND:

Peroral endoscopic myotomy (POEM) is a relatively new but increasingly therapeutic option for achalasia. In recent years, POEM has been used for nonachalasia esophageal motility disorders (NAEMDs), such as diffuse esophageal spasm, esophagogastric junction outlet obstruction, and hypercontractile disorder, with some clinical success. No studies thus far compare the outcomes of these two groups. We perform the first head-to-head comparison of outcomes after POEM in patients with achalasia and NAEMD.

PATIENTS AND METHODS:

A retrospective analysis of all patients undergoing POEM at one university hospital by a single expert endoscopist from July 2021 to December 2022 was performed. All patients were symptomatic, and the presence of esophageal motility disorders was confirmed using multiple diagnostic modalities. These patients were then divided into 2 groups, achalasia and NAEMD, based on the underlying diagnosis. Statistical analysis of different clinical outcomes, including effectiveness and safety, was performed.

RESULTS:

Thirty-seven patients (mean age: 59.55, females: 22) underwent POEM in the study period. Twenty patients had achalasia and 17 patients had NAEMD. The median myotomy length was 5.5 cm for the achalasia group and 10 cm for the NAEMD group. This excluded patients with esophagogastric junction outlet obstruction in which the median myotomy length was 3 cm. The procedure time, the duration of hospital stays, the rates of same-day discharge, and complications were similar between the two. Short-term outcomes of POEM for the two groups were similar with improvement in 94% of patients in the achalasia group and 93.75% in the NAEMD group.

CONCLUSION:

Contrary to prior observations, our study highlights that POEM is equally effective in achieving clinical improvement in patients with NAEMD as achalasia over 6 months of follow-up. In addition, POEM has a comparable safety profile in both patient groups making it a feasible therapeutic option for these debilitating and challenging disorders.

• Authors: Maryam Mubashir, Victoria Andrus, David Okuampa, Michelle Neice, Elizabeth Armstrong, Hailey Canezaro, Ross Dies, Ashely Deville, Lena Kawji, Shazia Rashid, Syed Musa Raza, Nazar Hafiz, Abu Saleh Mosa Faisal, Mohammad Alfrad Nobel Bhuiyan, Qiang Cai
• Journal: Surgical laparoscopy, endoscopy & percutaneous techniques (Surg Laparosc Endosc Percutan Tech) Vol. 33 Issue 6 Pg. 577-582 (Dec 01 2023) ISSN: 1534-4908 [Electronic] United States
• PMID: 37852237 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Female
• Humans
• Middle Aged
• Esophageal Achalasia (diagnosis, surgery, complications)
• Retrospective Studies
• Treatment Outcome
• Esophageal Motility Disorders (diagnosis, surgery)
• Myotomy (methods)
• Natural Orifice Endoscopic Surgery (methods)
• Esophageal Sphincter, Lower