Endoscopic Therapy Can Successfully Treat Post-POEM GERD

Peroral endoscopic myotomy (POEM) is increasingly being used as mainline therapy for patients with achalasia. After POEM, approximately 30% to 50% of patients experience abnormal esophageal acid exposure, whereas 10% have symptomatic gastroesophageal reflux disease (GERD) and erosive esophagitis. 

This study aimed to evaluate the efficacy of endoscopic full-thickness plication (EFTP) in treating GERD after POEM through a randomized sham-controlled trial involving 60 patients. The primary endpoint was an improvement in acid exposure time (AET) below 6%, and secondary endpoints included improvements in esophagitis, GERD questionnaire (GERDQ) scores, and proton pump inhibitor (PPI) usage. 

At 3 months, 69% of patients in the EFTP group achieved improvement in AET below 6%, which was significantly more than the 10.3% of patients who achieved this in the sham group. EFTP was also statistically superior to the sham procedure in improving esophageal AET, DeMeester Scores, and all reflux episodes (P<.001). Median scores at 3 and 6 months were significantly better in the EFTP group (P<.001), and a higher proportion of patients in the sham group versus the EFTP group continued to use PPIs (72% vs 28%). No major adverse events were reported in either group.