Posters
Presenting Author Academic/Professional Position
Student
Academic Level (Author 1)
Medical Student
Discipline/Specialty (Author 1)
Surgery
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Clinical Science
Abstract Type
Research/Clinical
Abstract
Introduction: Peroral endoscopic myotomy (POEM) is a treatment for achalasia that effectively reduces lower esophageal sphincter (LES) pressure. However, the literature lacks clarity on POEM's ability to restore esophageal peristalsis. We aimed to determine whether POEM improves esophageal peristalsis in achalasia patients across different achalasia subtypes and related motility disorders.
Methods: A retrospective review of a prospectively maintained, Institutional Review Board-approved, database was conducted for achalasia patients who underwent POEM between January 2015 and December 2023. Inclusion criteria required pre and/or post POEM High-Resolution Manometry (HRM) data. Paired T-tests were used to compare changes in HRM measurements from baseline to follow-up.
Results: A total of 128 patients were included (mean age 56.7 years; 39.1% male, 60.9% female). Indications for POEM included 20 type I achalasia, 52 type II, 30 type III, 18 EGJOO, and 6 Jackhammer esophagus. Post POEM, there was a significant reduction in LES residual pressure for all subtypes and EGJOO (p < 0.01), but not in Jackhammer esophagus (p = 0.26). In type I achalasia, LES residual pressure decreased from 19.4 to 11.7 (p = 0.01), in type II from 34.5 to 15.1, and in type III from 43.6 to 15.8mmHg. At follow up, peristaltic waves were observed in 55.0% of type I patients (11/20) and 57.7% of type II (30/52). For type I, the average Distal Contractile Integral (DCI) increased from 675.0 to 1040.1, and Mean Wave Amplitude (MWA) increased from 22.3 to 50.8. In type II, DCI increased from 1071.2 to 2610.9, with MWA rising from 53.7 to 57.8. For the combined type I and II group, peristalsis improved in 56.9% of patients (41/72).
Conclusion: POEM significantly reduces LES residual pressure across all achalasia subtypes. It also helps restore peristalsis in certain subtypes, with more than half of type I and II patients achieving at least one peristaltic wave.
Presentation Type
Poster
Recommended Citation
Vyas, Siddarth; Ward, Marc A.; Buckmaster, Brittany; Aladegbami, Bola; Wang, Christine; Ogola, Gerald; and Leeds, Steven G., "Does Per Oral Endoscopic Myotomy (POEM) Restore Esophageal Peristalsis in Patients With Achalasia?" (2025). Research Colloquium. 93.
https://scholarworks.utrgv.edu/colloquium/2025/posters/93
Included in
Does Per Oral Endoscopic Myotomy (POEM) Restore Esophageal Peristalsis in Patients With Achalasia?
Introduction: Peroral endoscopic myotomy (POEM) is a treatment for achalasia that effectively reduces lower esophageal sphincter (LES) pressure. However, the literature lacks clarity on POEM's ability to restore esophageal peristalsis. We aimed to determine whether POEM improves esophageal peristalsis in achalasia patients across different achalasia subtypes and related motility disorders.
Methods: A retrospective review of a prospectively maintained, Institutional Review Board-approved, database was conducted for achalasia patients who underwent POEM between January 2015 and December 2023. Inclusion criteria required pre and/or post POEM High-Resolution Manometry (HRM) data. Paired T-tests were used to compare changes in HRM measurements from baseline to follow-up.
Results: A total of 128 patients were included (mean age 56.7 years; 39.1% male, 60.9% female). Indications for POEM included 20 type I achalasia, 52 type II, 30 type III, 18 EGJOO, and 6 Jackhammer esophagus. Post POEM, there was a significant reduction in LES residual pressure for all subtypes and EGJOO (p < 0.01), but not in Jackhammer esophagus (p = 0.26). In type I achalasia, LES residual pressure decreased from 19.4 to 11.7 (p = 0.01), in type II from 34.5 to 15.1, and in type III from 43.6 to 15.8mmHg. At follow up, peristaltic waves were observed in 55.0% of type I patients (11/20) and 57.7% of type II (30/52). For type I, the average Distal Contractile Integral (DCI) increased from 675.0 to 1040.1, and Mean Wave Amplitude (MWA) increased from 22.3 to 50.8. In type II, DCI increased from 1071.2 to 2610.9, with MWA rising from 53.7 to 57.8. For the combined type I and II group, peristalsis improved in 56.9% of patients (41/72).
Conclusion: POEM significantly reduces LES residual pressure across all achalasia subtypes. It also helps restore peristalsis in certain subtypes, with more than half of type I and II patients achieving at least one peristaltic wave.
