Gastrointestinal endoscopy · 2026
Impact of gastric length of myotomy during POEM on the incidence of gastroesophageal reflux: A randomized controlled trial.
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Nabi Zaheer, Adepu Naveen, Inavolu Pradev, Samanta Jayanta, Rughwani Hardik, Singh Aniruddha Pratap, Pal Partha, Darisetty Santosh, Kotla Rama, Goud Rajesh, Kalpala Rakesh, Tandan Manu, Gupta Rajesh, Ramchandani Mohan, Lakhtakia Sundeep, Reddy D Nageshwar
Аннотация
BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is an effective treatment for achalasia cardia, but gastroesophageal reflux disease (GERD) remains a significant concern. The length of gastric myotomy may influence reflux outcomes, but high-quality data are lacking. This randomized controlled trial compared the incidence of GERD after short versus long gastric myotomy (SGM vs LGM) during POEM.
METHODS: In this randomized trial, we compared SGM (gastric myotomy <3 cm) with LGM (gastric myotomy≥3 cm) during POEM in cases with type I or II achalasia. The primary endpoint was significant reflux esophagitis defined as Los Angeles (LA) grade B or higher esophagitis at 6 months follow-up. Secondary endpoints included esophageal acid exposure (≥6% total acid exposure time [AET]) on 24-hour pH monitoring, reflux symptoms, proton pump inhibitor (PPI) use, Eckardt score, esophageal emptying, and high-resolution manometry parameters.
RESULTS: A total of 100 patients were randomly assigned to undergo either POEM with SGM (50 patients) or LGM (50 patients). Baseline characteristics were similar between groups. At 6 months, significant reflux esophagitis occurred in 24% (12/50) of SGM patients versus 44% (22/50) of LGM patients (p = 0.035; odds ratio, 2.45; 95% CI, 1.04-5.79). Upright acid exposure was significantly lower in the SGM group (median 0.75% vs 3.2%; p = 0.036). No differences were observed in reflux symptoms, PPI use, total AET, or clinical efficacy between groups.
CONCLUSIONS: SGM significantly reduces the incidence of LA grade ≥B esophagitis at 6 months following POEM, without differences in symptom burden, acid exposure, or clinical efficacy. (ClinicalTrials.gov number, NCT05500196).
METHODS: In this randomized trial, we compared SGM (gastric myotomy <3 cm) with LGM (gastric myotomy≥3 cm) during POEM in cases with type I or II achalasia. The primary endpoint was significant reflux esophagitis defined as Los Angeles (LA) grade B or higher esophagitis at 6 months follow-up. Secondary endpoints included esophageal acid exposure (≥6% total acid exposure time [AET]) on 24-hour pH monitoring, reflux symptoms, proton pump inhibitor (PPI) use, Eckardt score, esophageal emptying, and high-resolution manometry parameters.
RESULTS: A total of 100 patients were randomly assigned to undergo either POEM with SGM (50 patients) or LGM (50 patients). Baseline characteristics were similar between groups. At 6 months, significant reflux esophagitis occurred in 24% (12/50) of SGM patients versus 44% (22/50) of LGM patients (p = 0.035; odds ratio, 2.45; 95% CI, 1.04-5.79). Upright acid exposure was significantly lower in the SGM group (median 0.75% vs 3.2%; p = 0.036). No differences were observed in reflux symptoms, PPI use, total AET, or clinical efficacy between groups.
CONCLUSIONS: SGM significantly reduces the incidence of LA grade ≥B esophagitis at 6 months following POEM, without differences in symptom burden, acid exposure, or clinical efficacy. (ClinicalTrials.gov number, NCT05500196).