S936 E-POEM Outcomes in Patients With Spastic Esophageal Disorders: A Single Center Study

Introduction: Esophageal per-oral endoscopic myotomy (POEM) has arisen as an acceptable minimally invasive approach for the treatment of achalasia. It has been shown to be comparable to Heller myotomy (HM) in relation to safety, efficacy, and complications; outcomes are strong even in patients failing prior HM. In addition, POEM is increasingly being considered as a promising treatment for spastic esophageal disorders (SED). Although long-term data are limited, early studies suggest it may benefit patients unresponsive to prior therapies. This study explores the clinical success of POEM in these patients at our institution, including follow-up to 31 months. Methods: We reviewed all patients with SED treated with POEM from October 2021 to October 2023 at our institution. Each patient suffered from dysphagia, chest pain, or both. The diagnosis of distal esophageal spasm or hypercontractile esophagus was confirmed by esophagogastroduodenoscopy and high-resolution manometry. Pre-procedure and follow-up Eckardt scores were documented. Fisher’s exact test was used to compare differences in outcomes for myotomy length less than and greater than 10 cm. Results: Thirteen patients were reviewed, 62% of whom were women. The average age of patients was 62 years. POEM was successfully performed in all 13 patients; 1 patient underwent POEM twice for recurrence of symptoms. The follow-up time ranged from 2 weeks to 31 months. The average Eckardt score before POEM was 5; the average score at follow-up was 1.07. Eleven patients experienced symptom resolution at follow-up, with 1 patient experiencing minimal resolution of symptoms until POEM was repeated 5 months after the initial procedure, leading to resolution of symptoms at that time. The average procedure time was 26.1 minutes. Conclusion: Our study demonstrates the effectiveness of POEM in patients with SED refractory to medical therapy. Clinical success for esophageal disorders using the Eckardt score is generally defined as post-intervention Eckardt scores <3. While myotomy length has been discussed as a possible variable affecting outcomes, a systematic review did not find a difference in clinical success rate in studies where total myotomy length was greater than 10 cm versus studies with myotomy length less than 10 cm. Indeed, our study also demonstrated no measurable difference in POEM with myotomy length less than or greater than 10 cm. These results highlight the clinical utility of POEM for SED, but additional research is needed to corroborate these findings.