Changes in peristalsis following per oral endoscopic myotomy in common esophageal motility disorders

Per-oral endoscopic myotomy has been used for a diagnosis of achalasia and non-achalasia motility disorders. Little is known about the manometric function of the esophageal body and LES after POEM. This study focuses on examination of the changes before and after POEM in the treatment of all 3 achalasia types as well as esophagogastric junction outflow obstruction and jackhammer esophagus.

A prospectively maintained IRB approved database was retrospectively reviewed to find patients who were diagnosed with any type of achalasia, esophagogastric junction outflow obstruction, and jackhammer esophagus, and underwent POEM. Patients were included if they had pre-operative and post-operative high-resolution manometry. Primary endpoints were to identify changes in peristalsis as well as other manometric findings.

There were 265 patients who met the inclusion criteria. Type 1 achalasia showed the most change in restoration of peristalsis after POEM at 45.5% of patients. Type 2 achalasia improved peristalsis, but not significant from 46.8 to 60.3%. Type 3 achalasia patients lost some peristalsis from 82.5% of patient having peristalsis to 64.5% of patients after POEM. The DCI in these patients returned to a normal range after the procedure. Similar findings were seen in jackhammer esophagus where the DCI returned to a normal range. Esophagogastric junction outflow obstruction showed the biggest changes after POEM losing some peristalsis, but the DCI and wave amplitude significantly decreased (4993.2 to 902.5, 111 to 43.8, respectively).

Per-oral endoscopic myotomy is used for treatment of all types of achalasia and non-achalasia motility disorders. Peristalsis is regained in some patients with Type 1 and 2 achalasia, where some peristalsis is lost in Type 3 achalasia. Type 3 and jackhammer esophagus have normal DCI after the procedure, and esophagogastric junction outflow obstruction shows the poorest outcomes with some patients losing peristalsis, decrease in DCI and wave amplitude.