Efficacy of peroral endoscopic myotomy for the treatment of functional esophagogastric junction outflow obstruction.

Background and aims: Idiopathic or functional esophagogastric junction outflow obstruction (EGJOO) is characterized by preserved peristalsis and an elevated integrated relaxation pressure of the lower esophageal sphincter (LES) without mechanical obstruction. Data on efficacy of peroral endoscopic myotomy (POEM) in EGJOO are limited. Prior studies included heterogeneous patients and those with prior LES interventions such as pneumatic dilation and Heller myotomy. The aim of this study was to determine outcomes of POEM in EGJOO without prior pneumatic dilation or Heller myotomy. Methods: We reviewed medical records of patients who had POEM for EGJOO between 2014 and 2022 at our institution. The primary outcome was clinical success, defined as a reduction in Eckardt score to ≤3. Secondary outcomes were technical success, adverse events, reduction in LES pressure on high-resolution esophageal manometry (HREM), improvement in timed barium esophagram (TBE), and esophageal pH study findings. Results: Seventeen patients (9 female subjects; mean age 57.8 ± 14.4 years) met study criteria. POEM was technically successful in all patients, with no significant adverse events. Clinical success was achieved in 94.1% (16 of 17) of patients. There was a significant improvement in barium column height on TBE at 1 and 5 minutes (9.5 ± 6.2 cm vs 2.6 ± 2.6 cm [ Conclusions: POEM seems to provide high clinical success along with improvement in TBE and HREM in EGJOO; however, GERD is very common after POEM.