S2272 Two-Year Outcomes Following Esophageal Peroral Endoscopic Myotomy (E-POEM) for Non-Achalasia Esophageal Motility Disorders

Introduction: Non-achalasia esophageal motility disorders (NAEMDs) including esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), hypercontractile esophagus, and ineffective esophageal motility can cause debilitating symptoms. The Eckardt score (range 0-12), is a validated composite of dysphagia, chest pain, regurgitation, and weight loss, that is commonly used to quantify symptom severity. Esophageal peroral endoscopic myotomy (E-POEM) is a minimally invasive technique targeting the circular muscle layer of the esophagus, offering a possible therapeutic option for NAEMDs. Methods: Fourteen patients diagnosed with NAEMDs underwent E-POEM between July 2021 and December 2022 (mean age 56.3 years; 64% woman). Eckardt scores were assessed pre-procedure, 1-3 months post-procedure, and at 2-year follow-up. Paired t-test was used to compare scores at each interval. Mean differences and 95% confidence intervals (CI) were calculated. Results: Initial mean baseline Eckardt score was 7.5. At 1–3 months post-procedure, the mean score improved by 5.64 points (95% CI: 4.22-7.07; P = 0.00000107). At 2 years, the mean improvement from baseline was 4.07 points (95% CI: 2.05–6.09; P = 0.0008). A statistically significant increase in symptoms was observed between the early post-procedure and 2-year follow-up scores (mean difference = -1.57; 95% CI: -2.89 to -0.26; P = 0.0228), though overall improvement remained clinically and statistically significant. Conclusion: E-POEM provides significant short-term and long-term symptom relief in patients with NAEMDs, as measured by sustained improvement in Eckardt scores over 2 years. While a modest increase in symptom burden was noted over time, most patients continued to benefit from the procedure. These findings support E-POEM as an effective treatment for selected NAEMD patients. Further long term follow up and large-scale studies are warranted.