Peroral Endoscopic Myotomy Is Effective in Chronic Opioid Use-related Esophageal Motility Disorders

Prateek Sharma, MD, FASGE, reviewing Jacobs CC, et al. Gastrointest Endosc 2022 Dec 9.

Chronic opioid use can lead to a variety of esophageal disorders, including type III achalasia, esophagogastric outflow obstruction (EGJOO), diffuse esophageal spasm (DES), and hypercontractile esophagus (HE). The outcomes of peroral endoscopic myotomy (POEM) for these disorders related to opioid use have not been studied. 

This single-center retrospective study identified 89 patients (54% male; mean age, 61 ± 12.6 years; mean baseline Eckardt score, 6.9 ± 2.1) who had undergone POEM for type III achalasia, EGJOO, DES, or HE. Chronic opioid use was documented in 20% (18/89) of the study population, with oxycodone alone (33%) and hydrocodone alone (28%) being the 2 most commonly used medications. 

Six to 12 months after POEM, clinical response, GERD frequency, esophagitis prevalence, and proton pump inhibitor use were similar between opioid users and nonusers. Two years after POEM, clinical response was still similar between the 2 groups (70% opioid users, 87.5% nonusers; P=.33).

Prateek Sharma, MD, FASGE


One in 5 patients undergoing POEM for esophageal motility disorders have a history of chronic opioid use. POEM is a treatment option for these patients who have been unable to discontinue opioid use.



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.


Jacobs CC, Al-Haddad M, Stainko S, Perkins A, DeWitt JM. Prevalence and impact of opioid use in patients undergoing peroral endoscopic myotomy. Gastrointest Endosc 2022 Dec 9. (Epub ahead of print) (

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