Clinical efficacy and safety of short-length peroral endoscopic myotomy (POEM) compared with long-length myotomy for the treatment of achalasia

Background:
Previous evidence suggests that a short myotomy does not reduce the efficacy of peroral endoscopic myotomy (POEM) or increase intraoperative complications. However, the available studies are still limited and there has been no research in Latin America.
Objectives:
This study aims to evaluate whether POEM with a short myotomy differs significantly from a long myotomy in terms of efficacy and safety in patients with achalasia.
Design/Methods:
A retrospective cohort study including patients who underwent POEM for achalasia between 2017 and 2024. Efficacy was assessed according to the Eckardt scale at 6 months and at 1 year of follow-up. Safety was assessed for perioperative adverse events according to the iPOEM classification.
Results:
A total of 57 patients were included, 44% underwent short myotomy (median esophageal length of 5 cm; interquartile range (IQR) 4–5), and 56% long myotomy (median 11 cm IQR 10–13). 35% had previously undergone surgery for achalasia. The long myotomy group had more frequently minor complications such as emphysema (15.6% vs 0%; p = 0.039), capnoperitoneum (65.6% vs 16.0%, p < 0.001) and required more abdominal punctures (56.2% vs 12.0%, p < 0.001). There was no difference in the incidence of other complications. The probability of symptomatic response, defined as an Eckardt score ⩽ 3 at 12 months, was similar between groups (84.3% vs 88%, p = 0.69). The median operative time for the short myotomy was shorter (median 80 min; IQR 70–95 vs 127.5 min; IQR 102–155 min; p < 0.001).
Conclusion:
Short myotomy is not inferior to long myotomy in terms of clinical success and long-term reflux disease in the management of patients with achalasia. Furthermore, it offers advantages such as shorter procedure times and potentially lower rates of minor complications, making it the preferred option in most cases.