329 Peroral Endoscopic Myotomy (POEM) for Spastic Oesophageal Disorders: A Single-Centre Experience

Abstract Aim Spastic oesophageal motility disorders—including type III achalasia, diffuse oesophageal spasm, and hypercontractile (jackhammer) oesophagus—pose significant therapeutic challenges. Peroral endoscopic myotomy (POEM) is a minimally invasive procedure increasingly used for such cases. This study evaluates the technical success and clinical outcomes of POEM in patients with spastic oesophageal disorders using the Eckardt score as the primary measure. Method A retrospective review of 13 patients undergoing POEM for spastic oesophageal disorders was performed. All patients had full-thickness posterior myotomy. Symptom severity was assessed pre- and post-procedure using the Eckardt score. Statistical analysis was done using the Wilcoxon signed-rank test with significance set at p < 0.05. Results Thirteen patients were included (mean age: 60.5 ± 11.9 years; 54% female). The most common diagnosis was type III achalasia (46.2%), followed by jackhammer oesophagus (23.1%). The mean myotomy length was 20.2 ± 3.6 cm, and mean procedure time was 116.2 ± 28.7 minutes. Adverse events included capnoperitoneum requiring needle decompression in 23.1%. Clinical success (Eckardt score <3) was achieved in 84.6%. One patient had persistent symptoms due to EGJ holdup, and another experienced late recurrence requiring balloon dilatation. Mean Eckardt score improved significantly from 8.9 ± 3.5 to 2.3 ± 2.9 (p < 0.0001). Conclusions POEM is a safe and effective intervention for spastic oesophageal disorders, demonstrating significant symptom reduction and acceptable safety in this cohort. These findings are in line with outcomes from international multicentre experiences (Khashab et al., 2014)[1]. Reference: 1. Khashab MA, et al. International multicenter experience with peroral endoscopic myotomy .. GIE. 2014;79(5):718–725.