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