Peroral Endoscopic Myotomy for spastic esophageal motility disorders: a single-center retrospective analysis

Aims Non-achalasia spastic motility disorders of the oesophagus, including distal oesophageal spasm and hypercontractile oesophagus, are characterized by abnormalities in oesophageal peristalsis, not always involving the lower oesophageal sphincter. They share common features with other spastic motility disorder, type III achalasia, due to the presence of spasms that characterize the body of the oesophagus. The management of these diseases remain a challenge for the clinician. Since its introduction in clinical practice, Peroral Endoscopic Myotomy (POEM), with a long-myotomy, is actually recognize as a minimally invasive and effective treatment for type III achalasia. POEM has been successfully used also for the management of selected patients with non achalasia spastic oesophageal motility disorders, but few data are available about clinical success at a mid-term follow-up. The aim of this study is to assess peri-procedural and mid-term follow-up safety and efficacy of POEM for non-achalasia spastic motility disorders (NASMD) and to compare the outcomes with POEM performed for type III achalasia in a third-level endoscopic center.

Methods From July 2011 to March 2023, 97 patients with spastic motility disorder underwent POEM. As assessed by preoperative manometry, 21 patients were affected by non achalasia spastic motility disorder and 76 by type III of achalasia. The follow-up assessments, including 24h pH oesophageal monitoring, high-resolution manometry (HRM), and oesophagogastroduodenoscopy (EGD), were scheduled at 6 months, 2 and 5 years from the procedure.

Results As predicted, a significant difference was found in the mean preoperative 4sIRP, 14.5 mmHg in NASMD and 30.8 mmHg in type III achalasia [p<0,0001]. Mean age was 67.5 (± 12.6) and 58.3 (± 16.3) years in NASMD and type III achalasia, respectively (p<0.05). No differences were found in the other preoperative data (Eckardt score, duration of symptoms, BMI)[RL1]. POEM was successfully completed in all cases, involving the lower esophageal sphincter the myotomy in all precedures. No difference emerged in procedural details (procedure time, myotomy length, adverse event, feeding and discharge time). At midterm follow-up (30.7 months [SD±21.0]), clinical success was 95.2% in NASMD and 94% in type III achalasia. No differences have been detected about incidence of GERD assessed with pH monitoring and EGDS at six months follow-up.

Conclusions POEM is an effective and safe technique for spastic esophageal motility disorders, including the non-achalasia types. Our analysis showed similar results in performing POEM on type III achalasia and in non achalasia spastic disorders in terms safety, efficacy, clinical success and incidence of GERD, with a mid-term follow-up.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025