When less is more: Lower esophageal sphincter preserving per oral endoscopy myotomy (LES-POEM) is effective for non-achalasia esophageal motility disorders (NAEMD).

Jan 08, 2024

Experts: Varan Perananthan,Sunil Gupta,Anthony Whitfield,Ana Craciun,Oliver Cronin,Timothy O'Sullivan,Karen Byth,Mayenaaz Sidhu,Luke F Hourigan,Spiro Raftopoulos,Nicholas Graeme Burgess,Michael J Bourke

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.

Thieme. All rights reserved.

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ABOUT THE EXPERTS

Varan Perananthan,Sunil Gupta,Anthony Whitfield,Ana Craciun,Oliver Cronin,Timothy O'Sullivan,Karen Byth,Mayenaaz Sidhu,Luke F Hourigan,Spiro Raftopoulos,Nicholas Graeme Burgess,Michael J Bourke

Varan Perananthan

Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.

School of Medicine, University of Sydney, Sydney, Australia.

Sunil Gupta

Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.

Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia.

Anthony Whitfield

Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.

Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia.

Ana Craciun

Gastroenterology, Westmead Hospital, Sydney, Australia.

Department of Gastroenterology and Hepatology, Centro Hospitalar Universitario de Lisboa Norte, Lisboa, Portugal.

Oliver Cronin

Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.

Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia.

Timothy O’Sullivan

Gastroenterology, Westmead Hospital, Sydney, Australia.

Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia.

Karen Byth

Western Sydney Local Health District Research and Education Network, Westmead Hospital, Westmead, Australia.

University of Sydney, NHMRC Clinical Trials Centre, Camperdown, Australia.

Mayenaaz Sidhu

Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.

Luke F Hourigan

Gastroenterology, Princess Alexandra Hospital, Brisbane, Australia.

School of Medicine, The University of Queensland, Gallipoli Medical Research Institute, Brisbane, Australia.

Spiro Raftopoulos

Department of Gastroenterology, Sir Charles Gairdner Hospital, Nedlands, Australia.

Faculty of Medicine, The University of Western Australia, Perth, Australia.

Faculty of Medicine, Curtin University, Perth, Australia.

Nicholas Graeme Burgess

Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia.

School of Medicine, University of Sydney, Sydney, Australia.

Michael J Bourke

Gastroenterology, Westmead Hospital, Sydney, Australia.

Medicine, The University of Sydney Westmead Clinical School, Westmead, Australia.