Outcomes of peroral endoscopic myotomy in patients with cirrhosis: a multicenter experience.

BACKGROUND AND AIMS: Patients with cirrhosis and esophageal motility disorders are frequently excluded from peroral endoscopic myotomy (POEM) because of concerns related to portal hypertension and bleeding risk. As a result, data on POEM in this population are limited. We describe a multicenter experience evaluating the feasibility and short-term outcomes of POEM in patients with cirrhosis.

METHODS

We retrospectively reviewed patients with cirrhosis who underwent POEM at 6 U.S. tertiary centers between 2020 and 2024. Technical success was defined as completion of the myotomy without conversion or major intraprocedural bleeding. Clinical success was defined as a 6-month Eckardt score ≤3.

RESULTS

Twenty-four patients (mean age, 67.5 years; 10 females) underwent POEM, all of which were completed successfully. No intraprocedural or delayed variceal bleeding, transfusions, or procedure-related hepatic decompensation were observed. Follow-up Eckardt scores were available for 21 patients, of whom 18 (85.7%) demonstrated clinical improvement.

CONCLUSIONS

In this highly selected cohort treated at experienced centers, POEM was feasible and associated with symptomatic improvement without observed major bleeding. These findings represent an early experience and should be interpreted cautiously.