Modified POEM With Radial Extension for Achalasia: Short-Term Outcomes of a Prospective Single-Center Study

Achalasia is a rare esophageal motility disorder that causes dysphagia owing to impaired lower esophageal sphincter (LES) relaxation. This study aimed to evaluate a modified dissection and radial myotomy technique during peroral endoscopic myotomy (POEM) and to compare its outcomes with those of the standard approach.

This prospective, single-center study was conducted between February 2022 and December 2022. Eighty total with 80 achalasia patients undergoing POEM were divided into 2 groups: Group A (n=40), treated with the novel technique, and Group B (n=40), treated with the standard approach. Demographics, Eckardt score (ES), submucosal tunnel (ST), myotomy length, intervention duration, and adverse events were recorded. The follow-up period ranged from 3 to 20 months.

Patients who underwent the novel radial myotomy technique (Group A) had significantly longer myotomy lengths (11.8±2.4 vs. 8.1±2.0 cm, P <0.001), greater myotomy extension beyond the esophagogastric junction (4.2±0.8 vs. 2.7±0.6 cm, P <0.001), and improved postoperative Eckardt scores (median 1 [0-1] vs. 2, 1-3P =0.006) compared with the conventional POEM group (Group B). Subgroup analysis revealed that in Type III achalasia patients, the novel approach yielded longer submucosal tunnel lengths (15.6±0.8 cm, P =0.038) and favorable symptom relief. Despite extended dissection, there was no increase in gastroesophageal reflux disease (GERD)-related symptoms.

The novel dissection and radial myotomy technique demonstrated superior outcomes in reducing dysphagia symptoms and LES resistance compared with the standard approach. Tailoring ST and myotomy lengths based on the achalasia type and EGJ involvement may optimize outcomes without increasing the risk of GERD.