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Published on: March 3, 2023
Outcomes of peroral endoscopic myotomy in patients with cirrhosis: a multicenter experience
Muhammad Ali Butt1, Babak Mirminachi2, Lizeth Cifuentes2
1Division of Gastroenterology and Hepatology, University of Minnesota, Minneapolis, Minnesota, USA.
Insights
Peroral endoscopic myotomy (POEM) is feasible in patients with cirrhosis, showing symptom improvement without major bleeding. This early experience suggests POEM may be safe for selected cirrhotic patients with esophageal motility disorders.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Hepatology
Background:
- Cirrhosis patients with esophageal motility disorders are often excluded from peroral endoscopic myotomy (POEM) due to portal hypertension and bleeding risks.
- Limited data exists on POEM outcomes in this specific patient population.
- This study addresses the need for data on POEM feasibility and safety in cirrhotic patients.
Purpose of the Study:
- To evaluate the feasibility and short-term outcomes of peroral endoscopic myotomy (POEM) in patients with cirrhosis.
- To assess the safety profile of POEM in a cohort of cirrhotic patients.
- To determine the clinical success rate of POEM for esophageal motility disorders in patients with liver cirrhosis.
Main Methods:
- Retrospective review of 24 cirrhotic patients undergoing POEM across six U.S. tertiary centers (2020-2024).
- Technical success defined as successful myotomy completion without major intraprocedural bleeding.
- Clinical success defined by a 6-month Eckardt score of 3 or less.
Main Results:
- All 24 POEM procedures were technically successful.
- No intraprocedural or delayed variceal bleeding, transfusions, or hepatic decompensation occurred.
- 85.7% (18/21) of patients achieved clinical success (Eckardt score ≤3) at 6 months.
Conclusions:
- Peroral endoscopic myotomy (POEM) is a feasible procedure in a selected cohort of cirrhotic patients at experienced centers.
- POEM demonstrated symptomatic improvement without significant bleeding complications in this early experience.
- Findings suggest POEM may be a viable option for cirrhotic patients with esophageal motility disorders, but require cautious interpretation due to the early nature of the data.
Background And Aims:
Patients with cirrhosis and esophageal motility disorders are frequently excluded from peroral endoscopic myotomy (POEM) because of concerns related to portal hypertension and bleeding risk. As a result, data on POEM in this population are limited. We describe a multicenter experience evaluating the feasibility and short-term outcomes of POEM in patients with cirrhosis.
Methods:
We retrospectively reviewed patients with cirrhosis who underwent POEM at 6 U.S. tertiary centers between 2020 and 2024. Technical success was defined as completion of the myotomy without conversion or major intraprocedural bleeding. Clinical success was defined as a 6-month Eckardt score ≤3.
Results:
Twenty-four patients (mean age, 67.5 years; 10 females) underwent POEM, all of which were completed successfully. No intraprocedural or delayed variceal bleeding, transfusions, or procedure-related hepatic decompensation were observed. Follow-up Eckardt scores were available for 21 patients, of whom 18 (85.7%) demonstrated clinical improvement.
Conclusions:
In this highly selected cohort treated at experienced centers, POEM was feasible and associated with symptomatic improvement without observed major bleeding. These findings represent an early experience and should be interpreted cautiously.
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