Peroral endoscopic myotomy as retreatment for esophageal motility disorders: a propensity-matched analysis from a Western cohort.

BACKGROUND AND AIMS: The long-term outcomes of peroral endoscopic myotomy (POEM) in patients with prior treatment failure (PTF) remain uncertain. This study aimed to assess long-term outcomes in patients with PTF compared with treatment-naive patients.

METHODS

Consecutive patients who underwent POEM for esophageal motility disorders between March 2012 and March 2024 were retrospectively evaluated. Patients with at least 6 months of follow-up were included. Patients with PTF were defined as those who underwent previous treatments, including botulinum toxin injection, Heller myotomy, POEM, and pneumatic balloon dilation. Clinical failure (Eckardt score >3) and GERD-related outcomes were assessed. A 1:1 propensity score matching was performed. Kaplan-Meier curves and Cox proportional hazards regression were used to identify predictors of clinical failure.

RESULTS

Among the 564 patients who underwent POEM (median age, 57; 57.3% male; median follow-up, 36 months), 108 (19.1%) had undergone prior treatments. Patients with PTF had a significantly higher rate of clinical failure than treatment-naive group (21.3% vs 10.7%; P < .01). After matching, 130 patients (65 for each group) were analyzed. PTF was significantly associated with clinical failure (hazard ratio, 2.20; P = .04). No statistically significant difference was observed between groups in terms of clinical reflux (odds ratio [OR], 1.77; P = .193), ≥B grade esophagitis (OR, 1.52; P = .350), and acid exposure time ≥6% (OR, 1.72; P = .163).

CONCLUSIONS

Overall, POEM is feasible, safe, and effective for patients with PTF. However, the long-term clinical failure rate is higher than that in treatment-naive patients, emphasizing the need for closer monitoring and possibly enhanced interventions for these patients.