Peroral Endoscopic Myotomy Is Safe and Effective: A 10-Year Follow-Up of Patients

Peroral endoscopic myotomy (POEM), an endoscopic modality for managing major esophageal motility disorders, has gained popularity in the last decade. Multiple controlled studies and systematic reviews (3-5 years of follow-up) have reported a clinical success of more than 90%, along with a post-POEM GERD rate of approximately 30%. The authors of this single-center prospective study report the 10-year safety and efficacy of POEM. 

A total of 610 patients (median age, 55 years; body mass index, 26; 55.4% males) who underwent POEM between 2009 and 2019 were included in an initial pH study after POEM. A majority of the procedures were to treat achalasia (type II, 50.3%; type I, 26.2%; type III, 15.6%), whereas a lower number were for esophageal junction outflow obstruction (EGJOO, 2.21%), jackhammer esophagus (JE, 1%), or diffuse esophageal spasm (DES, 0.7%). 

Clinical success (post-POEM Eckardt score of 3), recorded annually for 7 years, was 97.6% (first year), 96.2%, 95.9%, 93.8%, 91.9%, 91.2%, and 91.2%, respectively. The mean post-POEM Eckardt score was higher in patients without achalasia (n=23; EGJOO, JE, or DES) than patients with achalasia (1.2 vs 0.8; P=.04). Accidental deep mucosal injuries were reported in 10.5% of the patients. 

In a follow-up pH study at least 3 years after the original pH study, 21 patients (3.4%) reported other significant adverse events (AEs): tunnel-opening dehiscences without leaks (n=3), delayed GI bleeding (n=8), and others (n=10); punctate esophageal perforation, narcotic-induced ileus, narcotic toxicity, aspiration pneumonia, atrial fibrillation, C difficile colitis in 2, mild pneumothorax, and 3 cases of prolonged fasting and observation in suspected AEs that did not occur in high-risk patients. None of these AEs led to invasive intervention, disability, or death. Of the patients with postprocedural GERD, 79.5% had no reflux or 1 reflux episode per week at 30 months, whereas paired pH studies at 5 and 57 months showed a reduction in positive results (67% to 43%; P=.003).