Peroral Endoscopic Myotomy Is Effective and Safe for Spastic Esophageal Motility Disorders

Spastic esophageal motility disorders (SEMDs) include a group of esophageal dysmotility conditions that are difficult to treat and often refractory to nonsurgical and/or endoscopic measures. These include type III achalasia, jackhammer esophagus (JHE), and distal esophageal spasm (DES), which cause dysphagia, regurgitation, and chest pain in many patients. 

This large, single-center study prospectively followed patients who underwent peroral endoscopic myotomy (POEM) for achalasia and esophageal motility disorders from 2013 through 2019. Of the 1115 POEM procedures, 6.6% were performed for SEMDs (n=74; males, 43; mean age, 43.5 ± 16.09 years), including 71.6% (n=53) for type III achalasia and 28.4% (n= 21) for JHE/DES. 

POEM was technically successful in all patients, defined as completion of the entire procedure, from submucosal injection to closure of the mucosal incision. Clinical success was defined as an Eckardt score ≤3, measured at months 1, 3, and 6 and every subsequent year after the procedure, and an improvement in postmyotomy integrated relaxation pressure (IRP) on manometry measured at month 3. Early clinical success was seen in 97.3% of patients at the 3-month follow-up. Median IRP after myotomy was 11 mmHg (7.8-13.4) for all patients, 11.8 mmHg (9.4-14.4) for type III achalasia, and 7.6 mmHg (6.1-10.1) for JHE/DES. The proportion of patients who completed short-term (1-3 years), medium-term (3-5 years), and long-term (>5 years) follow-up were 82.4%, 56.7%, and 31.5%, respectively. Long-term clinical success was reported in 82.6% (n=19) of 23 patients at >5 years. Moderate adverse events were reported in 4.1% (n=3) of total patients, including mucosal barrier failure (n=2) and delayed bleeding (n=1). At 3-month post-POEM follow-up, GERD was identified in 56.1% (n=36) of patients who underwent 24-hour pH impedance testing. In addition, 21.1% (n=16) of the study participants reported GERD symptoms, and erosive esophagitis was identified in 48.6% (n=36) of patients.