Efficacy of “redoPOEM” in the treatment of esophageal motility disorders: Results from a multicenter retrospective study

Aims Peroral endoscopic myotomy (POEM) has been widely adopted as a treatment for esophageal motility disorders, with a success rate of around 80-90%. However, approximately 10% of patients continue to experience symptoms after treatment, and data on second-line treatment strategies remain scarce. Our study aimed to evaluate the efficacy of “redoPOEM”, a repeat POEM procedure performed after an initial POEM failure, as a second-line therapy [1].

Methods We conducted a retrospective multicenter study involving 15 tertiary centers in France, including all patients who underwent redoPOEM for esophageal achalasia or non-achalasic motility disorders between April 2015 and September 2023. The procedure was deemed effective if the Eckardt score was<4 at three months post-procedure. Long-term effectiveness was defined as an Eckardt score<4 at the last follow-up with no need for additional treatment. Safety was assessed using the AGREE classification, with grade II or higher adverse events being considered significant.

Results A total of 91 patients were included in the study, of whom 66% were male, with a mean age of 54.6±18.0 years. Among these, 82 (90%) had esophageal achalasia, and 9 (10%) had a non-achalasic motility disorder. The average follow-up duration was 22 months (range: 3.5 to 69.5 months). The mean Eckardt score before redoPOEM was 5.8±2.0. There were no reported technical failures during the procedure. At the three-month follow-up, 79% of patients achieved clinical success, with a mean Eckardt score of 1.95±1.95. No significant difference in effectiveness was found between patients with achalasic and non-achalasic disorders (78.05% vs. 88.89%, p=0.679). Long-term success was observed in 57.7% of patients, with no significant variation between achalasic and non-achalasic cases (53.75% vs. 40%, p=0.663). Additionally, 25% of patients required additional treatments such as botulinum toxin injections, endoscopic dilation, or Heller myotomy. In univariate analysis, a high pre-redoPOEM Eckardt score was associated with primary failure. However, multivariate analysis revealed no significant predictive factors for failure. The safety profile was favorable, with 90% of patients experiencing no complications. Nine patients experienced grade II or higher adverse events: four were treated with antibiotics for pneumonia or mucosal breaches, while four others required repeat endoscopy due to mucosal breaches, managed with covered esophageal stents or hemostatic clips. One patient developed multiorgan failure.

Conclusions RedoPOEM is an effective technique for managing patients who experience primary failure or symptomatic recurrence after an initial POEM for motility disorders. The procedure shows promising results in both efficacy and safety, supported by the largest cohort of redoPOEM patients reported to date. Further research is necessary to compare redoPOEM with Heller myotomy and endoscopic dilation as second-line treatments for motility disorders.

Publication History

Article published online:
27 March 2025

• References

• 1 Nass KJ, Zwager LW, van der Vlugt M, Dekker E, Bossuyt PMM, Ravindran S. et al. Novel classification for adverse events in GI endoscopy: the AGREE classification. Gastrointestinal Endoscopy 2022; 95 (06): 1078-1085 e8