S966 Ten-Year Outcomes of Racial and Demographic Disparities in Peroral Endoscopic Myotomy (POEM) for Achalasia: A Nationwide Real-World Analysis

Introduction: Peroral endoscopic myotomy (POEM) is an established minimally invasive intervention for achalasia. However, disparities in utilization and clinical outcomes by race, ethnicity, sex, and age have not been well characterized in real-world U.S. practice. We aimed to evaluate 10-year outcomes following POEM, with a focus on demographic and racial/ethnic variation. Methods: We queried the TriNetX Research USA Network (2015-2025) for adults (≥18 years) diagnosed with achalasia (International Classification of Diseases-10: K22.0) who underwent POEM (Current Procedural Terminology: 43497). Patients with esophageal malignancy, pregnancy, or prior Heller myotomy were excluded. Primary outcomes included post-procedure gastroesophageal reflux disease (GERD), esophageal perforation, aspiration pneumonia, proton pump inhibitors (PPI) use, and all-cause mortality. Results were stratified by age, sex, race, and ethnicity. Results: Among 1,666 POEM recipients, 61% were White, 10% Black or African American, 3% Asian, and 6% Hispanic or Latino. GERD developed in 70.9% of patients, with higher rates in women (76.5%) and those >75 years (77%). Esophageal perforation occurred in 1.9% of the cohort but was disproportionately higher among Hispanic (9.1%) and Black (4.6%) patients. Aspiration pneumonia was noted in 5.8%, with elevated rates in Asian patients (28.6%) and those over 80 years (52.6%). All-cause mortality was 2.1% overall, but significantly elevated in Asian (28.6%) and Black (4.6%) groups. Hispanic or Latino patients also had the highest PPI utilization (9.1%), suggesting possible disparities in reflux symptom burden or management. Conclusion: In this 10-year, multicenter cohort study, POEM outcomes varied significantly across racial and ethnic groups. Minority populations were both underrepresented and experienced higher complication and mortality rates. These findings underscore the importance of equity-focused strategies in procedural care pathways, symptom monitoring, and post-POEM follow-up.