Peroral endoscopic myotomy: a Danish single center 10-year follow-up study

Achalasia is a rare esophageal motility disorder that in many cases can be treated effectively with Peroral Endoscopic Myotomy (POEM). However, long-term outcomes regarding clinical efficacy, patient satisfaction, and the prevalence of post-POEM gastro-esophageal reflux disease (GERD) remains elusive and thus require further investigation.

This retrospective cohort study followed 63 patients treated for achalasia with POEM. Clinical success (Eckardt-score ≤ 3, and no subsequent treatments), GERD prevalence (GerdQ-score ≥ 8), and patient satisfaction were assessed via medical record reviews and telephone interviews. Statistical analyses identified risk factors for treatment failure, lower levels of satisfaction, and GERD.

At a median follow-up of 10 years, clinical success was 74%. The average Eckardt-score improved from 7,6 pre-POEM to 2,16 (p < 0.0001). The majority of treatment failures occurred within three months post-POEM, with no new failures after 5 years. GERD symptoms were reported by 33% of patients. Patient satisfaction was high with 91% reporting to be satisfied or very satisfied. Treatment-naïve patients had higher success rates (85%) compared to those with prior Heller's myotomy (40%, p < 0.0001). No other risk factors for clinical failure were found. RePOEM showed superior outcomes for salvage treatment compared to balloon dilation, botulinum toxin injections, and Heller's myotomy.

POEM has a good and lasting efficacy at a median follow-up of 10 years. Clinical failure was not observed beyond 5 years post-POEM. The majority of patients were satisfied with POEM at follow-up. Symptomatic GERD was a highly experienced side effect at follow-up, however, not associated with lower levels of satisfaction.