Post written by Raymond E. Kim, MD, from the University of Maryland School of Medicine, Baltimore, MD, USA.

The primary focus of our study was to compare the difficulty and success rate of peroral endoscopic myotomy (POEM) in treatment-naïve cases versus treatment-refractory patients with esophageal motility disorders.

There is a prevailing belief that treatment-refractory cases, which typically result from failed Heller myotomy, pneumatic dilation, or Botox (Allergan, Madison, NJ, USA) injections, present more challenging circumstances because of the formation of scar tissue in the submucosal layer of the esophagus. Thus, we felt it was crucial to conduct this study to explore and better understand this phenomenon.

Our study found that prior treatment did not affect the clinical success rate of POEM and, interestingly, led to shorter case times and less tunneling difficulty. We hypothesize this may be partially because of previous treatment attempts leading to some relaxation of the lower esophageal sphincter.

The treatment-naïve group showed a higher occurrence of type I achalasia, likely because of the natural progression of the disease. We suggest that POEM should be considered a safe and feasible option for patients with treatment-refractory symptoms.

Graphical Abstract

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