Non-achalasia esophageal motility disorders (NAEMDs), encompassing distal esophageal spasm (DES) and hypercontractile esophagus (HE), are rare conditions. Per oral endoscopic myotomy (POEM) is a promising treatment option. In NAEMDs, unlike with achalasia, the lower esophageal sphincter (LES) functions normally, suggesting the potential for LES preservation during POEM.
This retrospective two-centre observational study focussed on patients undergoing LES-preserving POEM (LES-POEM) for NAEMD. Eckardt scores (ES) were assessed pre-POEM and at 6, 12 and 24-months post-POEM, with follow up endoscopy at 6-months to evaluate for reflux esophagitis. Clinical success, defined as an ES≤3, served as the primary outcome.
Over 84 months until May 2021, a total of 229 patients were recruited. Of these, 16 underwent LES-POEM for a NAEMD (9 with HE and 7 with DES). The median pre-POEM ES score was 6.0 (IQR 5.0 – 7.0), which decreased to 1.0 (IQR 0.0 – 1.8, p<0.001) 6-months post-POEM. This was sustained at 24 months, with an ES of 1.0 (IQR 0.0 – 1.8, p<0.001). Two patients (11.1%) developed Los Angeles (LA) grade A or B esophagitis.
LES-POEM for NAEMD demonstrates favourable clinical outcomes, with infrequent esophagitis and rare reintervention for LES dysfunction.
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