Clinical outcomes of repeat peroral endoscopic myotomy for recurrent esophageal achalasia: A case series

Achalasia is a rare esophageal motility disorder, and peroral endoscopic myotomy (POEM) is an effective treatment. However, symptom recurrence after POEM poses challenges for clinical management. This study aims to evaluate the short-term efficacy of repeat POEM (re-POEM) in patients with recurrent achalasia. This retrospective study included patients with achalasia who underwent re-POEM at Tongji University Affiliated East Hospital between March 2019 and June 2023. Data were collected on patient characteristics, perioperative details, and symptom assessments, including Eckardt scores (evaluating dysphagia, regurgitation, chest pain, and weight loss), the interval between initial and re-POEM, intraoperative and postoperative complications, and follow-up outcomes. Eight patients (aged 25-76 years, 2 males) underwent re-POEM successfully (including 2 cases of achalasia with concurrent esophageal spasm, and individualized treatment was carried out for these 2 patients, including a long muscle incision). Procedure duration ranged from 39 to 107 minutes. Within 6 months post-procedure, all patients experienced symptom relief. During follow-up, 7 patients maintained an Eckardt score of 0. One patient developed mild dysphagia, which was managed with balloon dilation, and another reported occasional mild acid reflux. Re-POEM appears to be a safe and effective therapeutic option for patients with recurrent achalasia. Patients with concurrent esophageal spasm also need more personalized treatment. These preliminary observations require confirmation in larger studies with longer follow-up.