Repeat peroral endoscopic myotomy: a salvage option for persistent/recurrent symptoms

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Digestive Motility Disorders

Background:

• Peroral endoscopic myotomy (POEM) is a primary treatment for achalasia.
• Some patients experience persistent or recurrent symptoms after POEM.
• Salvage therapy options are needed for these cases.

Purpose of the Study:

• To evaluate the feasibility, safety, and efficacy of repeat peroral endoscopic myotomy (Re-POEM).
• To assess Re-POEM as a salvage therapy for achalasia after initial POEM failure.

Main Methods:

• Retrospective analysis of 15 patients with persistent/recurrent achalasia symptoms post-POEM.
• Eckardt symptom score (ESS) used to define success (ESS ≤ 3).
• Evaluated procedure-related adverse events, lower esophageal sphincter (LES) pressure, and reflux symptoms.

Main Results:

• Successful Re-POEM in all patients, with a mean follow-up of 11.3 months.
• Significant reduction in mean ESS from 5.6 to 1.2 (P < 0.001).
• Mean LES pressure decreased from 25.0 to 9.5 mmHg (P < 0.001); 33.3% experienced reflux complications.

Conclusions:

• Re-POEM is a safe and effective salvage option for patients with failed initial POEM.
• The procedure provides significant short-term symptom relief.
• No serious complications were reported in the studied cohort.