Peroral plication of the esophagus as a treatment option for end-stage achalasia with sump formation.

INTRODUCTION

Peroral plication of the esophagus (POPE) can reduce sump size and improve symptoms in end-stage achalasia. However, its long-term efficacy and safety are unknown.

METHODS

Patients with end-stage achalasia who underwent POPE at our institution (2016-2024) were identified. Data were abstracted for patient demographics, procedural details, and clinical and radiographic outcomes.

RESULTS

Twelve patients underwent POPE. The technical success rate was 100%, with mean procedural time of 57 minutes and without adverse events. Symptomatic improvement occurred in 75% of patients (mean follow-up of 15 months), while 86% had radiographic improvement in sump size. Repeat POPE in 6 (50%) patients a mean of 2.6 years after index POPE and a third POPE in four (33%) patients a mean of 3.1 years later was performed, with similar technical success rates and outcomes to the index POPE.

CONCLUSIONS

POPE is a safe and repeatable long-term therapeutic option in end-stage achalasia.