Peroral endoscopic myotomy is effective and safe in non-achalasia esophageal motility disorders: an international multicenter study

Background and study aims The efficacy of per oral endoscopic myotomy (POEM) in non-achalasia esophageal motility disorders such as esophagogastric junction outflow obstruction (EGJOO), diffuse esophageal spasm (DES), and jackhammer esophagus (JE) has not been well demonstrated. The aim of this international multicenter study was to assess clinical outcomes of POEM in patients with non-achalasia disorders, namely DES, JE, and EGJOO, in a large cohort of patients. Patients and methods This was a retrospective study at 11 centers. Consecutive patients who underwent POEM for EGJOO, DES, or JE between 1/2014 and 9/2016 were included. Rates of technical success (completion of myotomy), clinical response (symptom improvement/Eckardt scores 3), and adverse events (AEs, severity per ASGE lexicon) were ascertained. Results Fifty patients (56% female; mean age 61.7 years) underwent POEM for EGJOO (n=15), DES (n=17), and JE (n =18). The majority of patients (68%) were treatment-naive. Technical success was achieved in all patients with a mean procedural time of 88.4 +/- 44.7 min. Mean total myotomy length was 15.1 +/- 4.7 cm. Chest pain improved in 88.9% of EGJOO and 87.0% of DES/JE (P=0.88). Clinical success was achieved in 93.3% of EGJOO and in 84.9% of DES/JE (P= 0.41) with a median follow-up of 195 and 272 days, respectively. Mean Eckardt score decreased from 6.2 to 1.0 in EGJOO (P<0.001) and from 6.9 to 1.9 in DES/JE (P<0.001). A total of 9 (18%) AEs occurred and were rated as mild in 55.6% and moderate in 44.4%. Conclusion POEM is effective and safe in management of non-achalasia esophageal motility disorders, which include DES, JE, and EGJOO.