Who Needs Endoscopic Removal of Food Residue From the Esophagus Before Peroral Endoscopic Myotomy for Esophageal Achalasia and Esophagogastric Junction Outflow Obstruction?

OBJECTIVES

Peroral endoscopic myotomy (POEM) is an established treatment for esophageal achalasia. Despite favorable outcomes, the risk of reflux aspiration during general anesthesia induction in POEM remains a concern. This study aimed to identify the risk factors for food residue in the esophagus before POEM and evaluate the necessity of esophagogastroduodenoscopy (EGD) and cleansing the day before POEM.

METHODS

A retrospective analysis of 61 patients with esophageal achalasia and esophagogastric junction outflow obstruction undergoing POEM between July 2017 and March 2024 was performed. Patients were divided into two groups based on the presence of food residue observed during preoperative EGD: residual (n = 16) and no-residual (n = 45) food groups. The factors compared included age, sex, Chicago criteria, duration of symptoms, Eckardt score, integrated relaxation pressure, esophageal dilation grade and type on esophagography, and presence of residual food during the initial EGD.

RESULTS

In univariate analysis, residual food was more common in patients aged <60 years (p < 0.05) and those with higher esophageal dilation grades (p < 0.05). Additionally, residual food during the initial EGD was identified as a significant predictor (p < 0.05).

CONCLUSIONS

Preoperative EGD and esophageal cleansing the day before POEM may be warranted in patients with initial EGD-detected residue, younger age, and marked dilation, to reduce reflux aspiration risk and improve procedural safety.