Short POEM as Good as Long POEM for Achalasia Treatment

For the treatment of patients with achalasia, peroral endoscopic myotomy (POEM) has shown comparable effectiveness to surgery. During POEM, the typical length of the myotomy is 12 to 13 cm. However, shorter incisions may offer advantages, such as reduced procedure time and potentially lower rates of gastroesophageal reflux disease (GERD). This randomized clinical trial involving 200 patients compared the effectiveness of long-POEM (13 cm) and short-POEM (8 cm) procedures for achalasia treatment. 

The primary outcome of achieving an Eckardt symptom score of ≤3 at 24 months showed noninferiority between the two groups. The clinical success rates were 89.1% in the long-POEM group and 98.0% in the short-POEM group, resulting in a difference of -8.9% (90% confidence interval, -14.5 to -3.3). The short-POEM procedure had a significantly shorter operating time of 40 minutes compared with 50 minutes for long POEM. 

Both groups had similar rates of severe adverse events, postoperative GERD, endoscopic esophagitis, and proton pump inhibitor use. Acid exposure >6% at 6 months was observed in 34.3% of the long-POEM group and 32.1% of the short-POEM group. Endoscopic esophagitis was diagnosed in 36.6% of the long-POEM group versus 50.5% of the short-POEM group at 6 months and 21% versus 24.7%, respectively, at 24 months. Regular proton pump inhibitor use did not differ significantly between the groups (36.8% [long POEM] vs 37.5% [short POEM]).