S968 POEM Does Not Trigger Barrett’s Esophagus: A Multicenter TriNetX Study of Barrett’s Esophagus Prevalence

Introduction: Per-oral endoscopic myotomy (POEM) has become the standard therapy for achalasia, but its potential to promote Barrett’s esophagus (BE) is unclear. Given the high rate of post-POEM gastroesophageal reflux disease (GERD), a known risk factor for BE, we sought to determine whether POEM independently increases BE incidence. Methods: We queried the TriNetX Research Network (99 U.S. health-care organizations) for adults ≥18 years with achalasia (International Classification of Diseases (ICD)-10 K22.0) who underwent POEM (Current Procedural Terminology 43497) between May 1, 2005, and May 1, 2025. Patients with pre-existing BE, upper-gastrointestinal malignancy, eosinophilic esophagitis, pregnancy, esophagectomy, or anti-reflux surgery were excluded. The primary outcome was first-ever BE (ICD-10 K22.7) occurring ≥1 day post-POEM. For context we also assessed gastroesophageal reflux with esophagitis (GERD-E: ICD-10 K21.0) as a surrogate of reflux burden. Incidence proportions and prevalences were calculated for 2 prespecified eras—Era 1 (May 1, 2015-May 1, 2020) and Era 2 (May 2, 2021-May 1, 2025)—with stratification by sex, race, and ethnicity. Results: Among 1,882 POEM recipients, no incident BE occurred in either era (0/1,882; incidence 0%, prevalence 0%, all demographic strata 0%). Conversely, GERD-E rose 4-fold: incidence 5.8% in Era 1 versus 22.4% in Era 2, and prevalence 7.7% versus 26.9%. Women showed slightly higher GERD-E incidence than men in the recent era (23.5% vs 21.5%); the largest absolute increases were observed among Asian (34%) and Black (17%) patients. Conclusion: In this national real-world cohort spanning a decade of modern POEM practice, no cases of de novo Barrett’s esophagus were identified, despite a marked escalation in reflux-associated esophagitis. These data suggest that POEM, even in the face of increasing post-procedure reflux, does not confer measurable risk for BE within the first 10 years. Routine Barrett’s surveillance solely on the basis of prior POEM appears unwarranted; attention should instead focus on symptomatic reflux control and longer-term follow-up to confirm these reassuring findings.