Swei Eric, Kassir Zachary, Shrigiriwar Apurva Pravin, Schlacterman Alex, Chung Chen-Shuan, Mandarino Francesco Vito, Kedia Prashant, Messman Helmut, Pawa Rishi, Desai Pankaj, Saxena Payal, Assefa Redeat, Arevalo-Mora Martha, Azzolini Francesco, Arcidiacono Paulo Giorgio, Nagl Sandra, Abu-Hammour Mohamad-Noor, Puga-Tejada Miguel, Baquerizo-Burgos Jorge, Egas-Izquierdo Maria, Cunto Domenica, Alcivar-Vasquez Juan, Del Valle Raquel, Sharaiha Reem Z, Irani Shayan, Medranda Carlos-Robles, Khashab Mouen
Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Department of Medicine, Baltimore, Maryland, USA.
Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
Gastrointest Endosc. 2025 Feb;101(2):377-384.e2. doi: 10.1016/j.gie.2024.08.025. Epub 2024 Sep 7.
Patients with sigmoid-type achalasia can be challenging to treat with peroral endoscopic myotomy (POEM). A short myotomy improves technical success; however, outcomes have not previously been evaluated.
This was a multicenter, international, retrospective study of patients who underwent POEM with short (≤4 cm) or standard esophageal myotomy. Outcomes included clinical and technical success, procedural adverse events, and reflux rates.
A total of 109 patients with sigmoid achalasia (sigmoid, n = 74; advanced sigmoid, n = 35) underwent POEM across 13 centers (short myotomy, n = 59; standard, n = 50). Technical success was 100% across both groups. Patients who underwent short myotomy had a significantly shorter mean procedure time (57.7 ± 27.8 vs 83.1 ± 44.7 minutes, P = .0005). A total of 6 adverse events were recorded in 6 patients (5.5%; 4 mild, 2 moderate); the adverse event rate was not significantly different between short and standard groups. Ninety-eight patients had follow-up data (median, 3.6 months; interquartile range, 1-14 months). Clinical success was 94% (short, 93%; standard, 95%; P = .70) and did not differ based on achalasia subtype or sigmoid achalasia severity. Twenty-one (22%) patients reported post-POEM reflux and 44% (16 of 36) had objective evidence of pathologic reflux. Rates of pathologic reflux were significantly increased in the standard versus short group (odds ratio, 18.0; 95% confidence interval, 2.0-159.0; P = .009).
POEM with short myotomy is effective and safe for the short-term treatment of sigmoid and advanced sigmoid achalasia. Short myotomy may lead to less reflux than standard myotomy.
