Efficacy and safety of POEM in patients with failed previous myotomies: a prospective case series

Aims Heller myotomy (HM) or peroral endoscopic myotomy (POEM) are established treatments for esophageal motility disorders (EMDs). In cases of failure, management options include repeat myotomy (surgical or endoscopic) or pneumatic dilation. As POEM is a specialized technique performed in selected centers, there is limited information regarding its efficacy and safety in previously treated patients. The primary objective was to describe the outcomes of POEM in patients with EMD after failed HM or POEM.

Methods A prospective observational study was conducted at the University Hospital of Navarra (HUN) from 2016 to March 2023, including patients with EMD treated with POEM after failed prior myotomy (HM or POEM). All patients with an Eckardt score>3 following myotomy were included. Continuous variables were summarized as mean, median, and interquartile range (IQR). Categorical variables were described using absolute and relative frequencies.

Results A total of 33 patients were included, 28 with failed HM and 5 with failed POEM, with a mean age of 52.3 years (SD 15.7). All patients underwent a second, endoscopic myotomy. Clinical response (Eckardt<3) was achieved in 89.3% of patients with POEM after failed HM and in 80% of patients after failed POEM.

Complications in the post-HM group included one case of intraprocedure bleeding and one case of cardial ulcer. In the redo-POEM group, one instance of transient blindness associated with subcutaneous emphysema was recorded [1] [2].

Conclusions POEM remains a highly effective and safe technique for patients with failed prior surgical or endoscopic myotomies, offering a viable therapeutic option in this challenging clinical scenario.

Publication History

Article published online:
27 March 2025

• References

• 1 Nabi Z, Ramchandani M, Basha J. et al. Per-oral endoscopic myotomy in cases with prior Heller's myotomy: Outcomes at a median follow-up of 5 years. Journal of Gastroenterology and Hepatology 2023; 38 (11): 2035-2039
• 2 Ichkhanian Y, Assis D, Familiari P. et al. Management of patients after failed peroral endoscopic myotomy: a multicenter study Endoscopy. 2020; doi:10.1055/a-1312-0496.