Peroral Endoscopic Myotomy as an Emergent Treatment in Hospitalized Patients with Esophageal Motility Disorders.
Objective: The role of Peroral Endoscopic Myotomy (POEM) as an emergent treatment for hospitalized patients with esophageal motility disorders and acute feeding incapacity is not well established. This study evaluates the effectiveness and safety of POEM as an inpatient intervention for this group.
Methods: This retrospective multicenter study included patients aged ≥18 years who were hospitalized for severe symptoms of esophageal motility disorders and underwent emergent POEM during the same admission at 17 international centers from 3/2012 to 1/2024.
Results: A total of 179 patients (57% female; mean age 56±21 years) were included. Of these, 160 had achalasia (Type I: 40 [22.3%], Type II: 89 [49.7%], Type III: 31 [17.3%]), and 19 had non-achalasia disorders including esophagogastric junction outflow obstruction (n=9), jackhammer esophagus (n=1), distal esophageal spasm (n=1), and unknown diagnosis (n=8). The median baseline Eckardt score (ES) was 9 (IQR:8-11). At admission, 57.1% of patients were on a no-oral diet, and 36.2% were on a liquid-only diet. POEM was technically successful in 176 patients (98.3%). At discharge, 79 patients (44.9%) were on a liquid-only diet, 79 (44.9%) on soft solids, and 18 (10.2%) on a complete diet, representing a significant dietary improvement (P<0.001). The median ES improved to 1 (IQR:1-2) at discharge (P<0.001). Adverse events occurred in 4 patients (2.3%), including 2 mild (managed conservatively), 1 moderate (bleeding treated with clips), and 1 severe (leak managed with clips). The median post-POEM hospital stay was 2 days (IQR:1-4). Clinical success, defined as ES ≤3, was achieved in 81.9% at a median of 45.5 weeks. The median ES at follow-up decreased to 1 (IQR:0-3) (P<0.001).
Conclusions: POEM is a safe and highly effective emergent treatment in hospitalized patients with esophageal motility disorders and acute feeding incapacity, providing rapid symptom relief and significant dietary improvements.