Peroral Endoscopic Myotomy Is Also Effective in Patients With Prior Achalasia Treatment

Peroral Endoscopic Myotomy Is Also Effective in Patients With Prior Achalasia Treatment

Prateek Sharma, MD, FASGE, reviewing Kadiyala J, et al. Gastrointest Endosc 2023 Feb 3.

Some studies suggest that prior treatment may increase the difficulty and success of tunneling during a peroral endoscopic myotomy (POEM) procedure, but recent studies have demonstrated similar outcomes between treatment-naïve patients and those with treatment failure undergoing POEM. The current study aimed to determine whether prior treatment with Botox, pneumatic dilation (PD), or laparoscopic heller myotomy (LHM) was associated with longer procedure times, increased failure rates, or a lower rate of symptomatic relief in patients undergoing POEM for achalasia or spastic esophageal pathologies. 

The study included 95 patients (mean age 55.6 years, 45% female) who underwent POEM for achalasia and spastic esophageal pathologies between February 2017 and September 2021. Of the POEM procedures, 25 were for type I achalasia, 31 for type II, and 33 for spastic esophageal pathologies. Patients with prior treatment by Botox (n=18), dilation (n=17), or LHM (n=3) were designated as the “treatment-refractory” group, and those without prior treatment as the “treatment-naïve group.” The primary outcomes were clinical success and procedure difficulty, with data collected on patient demographics, previous treatment, preprocedure and postprocedure Eckardt scores (ES), distensibility indices, and procedure times. 

The study found that prior treatment with Botox injections, PD, or LHM was associated with decreased case time and easier tunneling during POEM, and there was no significant difference in post-ES or technical success between the groups.

Prateek Sharma, MD, FASGE


Prior treatment with Botox, PD, or LHM does not have a negative impact on the clinical or technical success of POEM for achalasia or spastic esophageal pathologies. Instead, prior treatment can be associated with a shorter procedure duration and decreased difficulty.



Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Kadiyala J, Canakis A, Lee DU, Xue P, Fan GH, Kim RE. Comparing clinical success and procedural difficulty between treatment-naïve and treatment-refractory patients with esophageal motility disorders during per oral endoscopic myotomy. Gastrointest Endosc 2023 Feb 3. (Epub ahead of print)(

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