Outcomes of peroral endoscopic myotomy in patients with spastic esophageal motility disorders that do not fulfill Chicago Classification criteria

ABSTRACT

Introduction: per-oral endoscopic myotomy (POEM) hasbecome a mainstream treatment for achalasia and is apromising therapy in spastic disorders.Methods: this is a retrospective study of prospectively collected data (case series). We present the first results of theuse of POEM in patients with atypical spastic esophagealmotor disorders that do not satisfy current Chicago Classification criteria. Seven consecutive patients with troublesome and persistent symptoms (12-180 months) relatedto atypical spastic esophageal motor dysfunction weresystematically assessed before and after POEM, the extentof which was tailored by manometric findings. In five ofthe patients, other endoscopic or surgical procedures hadfailed.Results: high-resolution manometry (HRM) showed a spasticesophageal body contractile segment in varying positionsand lengths along the esophageal body which did not meet Chicago Classification criteria. After POEM, dysphagia and/or chest pain had either resolved or was greatly reduced.HRM 3-6 months after myotomy showed that the regions ofspastic contraction targeted by myotomy had been ablated.There were no major complications. The clinical responseswere fully maintained up to the most recent assessmentsafter POEM (range 7-44 months).Conclussion: in our seven patients, POEM was a highly effective treatment for patients with troublesome symptoms related to atypical spastic esophageal motility disorders. (AU)