Outcome of Short Posterior Myotomy in Patients with Achalasia Cardia

Background and Study Aim: Peroral endoscopic myotomy (POEM) is an established treatment option for achalasia cardia. Various modifications have been proposed to mitigate the risk of gastroesophageal reflux disease (GERD) following POEM. In our study, we investigate the safety and efficacy of a 4 cm short posterior myotomy.

Methods: Present study is retrospective analysis of prospectively collected data of all consecutive patients of achalasia cardia treated with short posterior myotomy between February 2021 and December 2023. Demographic, procedure-related, and other clinical details were collected from database. Patients were either seen at clinic or contacted telephonically to gather data on efficacy and GERD symptoms. Patients who completed at least 1 year of follow-up were included in study. Patients with type III achalasia cardia were excluded. Clinical details collected during last visit or telephonic contact were considered for analysis. Clinical success was defined as Eckardt score ≤3 after POEM. “GERDQ score” of >8 established clinically significant GERD, postprocedure.

Results: A total of 234 patients underwent short posterior myotomy in aforementioned duration, out of which 165 patients (mean age: 44.52 ± 17 years) completed at least 1 year follow-up. Mean duration of follow-up period was 22.16 ± 7.0 months. POEM could be successfully completed in all 165 (100%) patients. Clinical success at last follow-up is 97.5%. Mean Eckardt score reduced from 6.8 ± 1.05 to 0.41 ± 1.09 (p ≤ 0.0001) after the procedure. Clinical success was 100 and 95.5% for Type I and Type II achalasia cardia, respectively. Clinically significant GERD occurred in 21.85% of patients.

Conclusion: A short posterior myotomy is safe and effective treatment option for patients with Type I and Type II achalasia cardia.

Publication History

Article published online:
22 April 2024