S2315 Prevalence, Predictors, and Outcomes of Post-POEM GERD in Achalasia: Endoscopic and Quality-of-Life Assessment

Introduction: Peroral endoscopic myotomy (POEM) is an increasingly utilized treatment for achalasia. While effective in relieving dysphagia, POEM carries a risk of gastroesophageal reflux disease (GERD), though the true incidence and severity of post-POEM GERD remain unclear. This study aims to evaluate GERD following POEM, including its prevalence, long-term complications and impact on quality of life. Methods: This single-center retrospective study analyzed achalasia patients who underwent POEM between 10/2017 and 3/2025. Baseline data included Eckardt scores, upper endoscopy (EGD), EndoFLIP, and high-resolution manometry findings. Post-procedure GERD was assessed via EGD, and its subjective impact was evaluated using GERD Health-Related Quality of Life (GERD-HRQL) questionnaire (score range: 0–75); a higher score denotes worse symptoms. Results: A total of 152 patients were included, with a mean baseline Eckardt score of 7.37 (mean follow up, 15.2 months). Posterior tunnel location (70%) and circular myotomies (65%) were most frequently performed, with an average myotomy length of 101 mm. Mean post-procedure Eckardt score was 1.17. Younger patients with more severe baseline symptoms had greater symptom improvement. Post-POEM GERD was identified on initial EGD in 7.2% (n = 11) of patients. Subsequent follow up EGDs noted evidence of GERD in 3.3% (n = 5), 2 of whom had identified GERD on index post-POEM EGD with progression of esophagitis and new peptic stricture formation. GERD incidence was associated with older age, higher baseline Eckardt scores, higher baseline EGJ-DI, and longer myotomy lengths. Among the 47 patients who completed the GERD-HRQL, the average score was 14.4. Overall, 77% of patients reported satisfaction with their reflux symptoms, while 13% were dissatisfied and 10% were neutral. Higher GERD-HRQL scores were observed in younger patients and those with full-thickness myotomies; this group also had more frequent clinic visits and follow-up EGDs. Only 3 cases required subsequent fundoplication, all with achalasia type III and lower baseline IRP values. No correlation was found between achalasia subtype and GERD incidence. Conclusion: POEM is an effective intervention with low rates of post-procedure GERD, as well as minimal reflux-related complications and symptom burden. However, several factors were found to increase the risk of post-POEM GERD, emphasizing the importance of personalized procedural planning and close follow up in high-risk patients.