RedoPOEM: efficacy and safety after failure of a first POEM for esophageal motility disorders.

INTRODUCTION

Per-oral endoscopic myotomy (POEM) achieves an 80-90% success rate for the treatment of esophageal motility disorders, but approximately 10% of patients experience persistent symptoms. This study evaluated the results of a repeat POEM procedure, or redoPOEM, as a second-line therapy.

METHODS

We conducted a retrospective multicenter study involving 15 French tertiary centers, including all patients undergoing redoPOEM between April 2015 and September 2023. Short and long-term success rates were defined as an Eckardt score < 4 at 3 months, and at the last follow-up visit with no need for additional treatment, respectively. Adverse events were graded using the AGREE classification.

RESULTS

Eighty-seven patients (mean age 56.5 years, 57% male) were included; 89.7% had achalasia and 10.3% had non-achalasia motility disorders. The median pre-redoPOEM Eckardt score was 6. The average follow-up duration was 22 months. At 3 months, 78.2% achieved clinical success (median Eckardt score: 1). Long-term success was obtained in 57.1% at 1 year follow-up. Additional treatments were required in 28%. Univariate and multivariate analyses identified a high pre-redoPOEM Eckardt score and prior treatments before POEM as predictors of failure. Adverse events (grade II or higher) occurred in 11.4%, including pneumonia and mucosal breaches, but no deaths were reported.

CONCLUSION

RedoPOEM is effective and safe for managing primary failure or symptomatic recurrence after a first POEM. A high pre-redoPOEM Eckardt score and previous treatments are predictive of primary failure.

CLINICAL TRIALS NUMBER: NCT06044155.