Salvage peroral endoscopic myotomy is a promising treatment for achalasia following a myotomy failure.

BACKGROUND AND AIMS: Reintervention modalities following myotomy failure in achalasia patients have yet to be established. The efficacy and safety of salvage peroral endoscopic myotomy (POEM) for treatment of achalasia following a myotomy failure were evaluated in the study.

METHOD: Between August 2011 to August 2021, at the Endoscopy Center of Zhongshan Hospital, 219 achalasia patients who had previously undergone a myotomy underwent a salvage POEM and were thus retrospectively enrolled in this study. After propensity score matching (PSM), operation-related parameters were compared between the salvage POEM group and the naïve POEM group. Subgroup analysis was performed between patients with previous heller myotomy (HM) and patients with previous POEM.

RESULT: With similar baseline characteristics between both groups after PSM, the salvage POEM group presented with shorter tunnel length (11.8±2.2 vs. 12.8±0.9, p<0.0001) and myotomy length (9.8±2.0 vs. 10.4±1.0, p<0.0001) than the naïve POEM group. There were no significant differences in procedure-related adverse events (AEs) between patients of salvage POEM and naïve POEM. The primary outcome of treatment success occurred in 175 of 193 patients (90.7%) in salvage POEM group vs. 362 of 374 patients (96.8%) in naïve POEM group (p = 0.0046). Significantly higher rate of clinical failures were observed at the 2-year and 5-year follow-ups in the previous HM subgroup than the previous POEM subgroup (p = 0.0433, p = 0.0230, respectively).

CONCLUSION: Salvage POEM following a previous myotomy failure, especially after POEM failure, is a promising treatment option as it has a durable clinical relief rate.