Post written by Deliang Liu, MD, PhD, from the Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China.

The study focus on comparing the outcomes between standard myotomy versus short myotomy for the management of treatment-naïve patients with type II achalasia.

Numerous studies demonstrated that POEM was a safe and effective treatment in patients with achalasia. But a major concern for POEM has been the high rate of gastroesophageal reflux disease (GERD). A recent meta-analysis reported that acid reflux occurs more frequently after POEM procedure than after LHM (laparoscopic Heller myotomy) procedure. Actually, LHM is frequently combined with anti-reflux partial fundoplication procedure, which has been shown to significantly reduce the risk of postoperative reflux. Yet POEM is typically performed without anti-reflux procedure. Thus, it is of great significance to determine the procedural factors associated with GERD after POEM.

Our results indicated, among treatment-naive patients with type II achalasia, short esophageal myotomy was comparable in terms of providing treatment efficacy and improving quality of life at 1 year. Whereas, short POEM is technically simpler to perform and requires less procedure time. Moreover, the short POEM approach resulted in fewer cases of post-operative abnormal esophageal acid exposure.

The long-term rates of adverse reflux esophagitis need to be further validated given the significant difference in the rates of abnormal esophageal acid exposure. Large-scale RCT studies are warranted to validate the relief of dysphagia at long-term follow-up.

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