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The following is a summary of “Utility of Intraprocedural Luminal Diameter and Distensibility Measurements During the Esophageal Peroral Endoscopic Myotomy Procedure,” published in the November 2024 issue of Gastroenterology by Eke et al.  

Achalasia is a rare disorder causing impaired relaxation of the lower esophageal sphincter (LES) and reduced peristalsis. Peroral endoscopic myotomy (POEM) is an effective treatment but may lead to reflux and esophagitis.  

Researchers conducted a retrospective study assessing clinical response to POEM and post-procedure reflux risk.  

They reviewed the electronic medical records of 168 patients who underwent POEM for achalasia (May 2014 to May 2021) at 2 tertiary care centers. An endoluminal functional lumen imaging probe (EFLIP) was used to assess LES dynamics, with changes in myotomy length occurring in 5% of cases. Pre- and post-procedure Eckardt Symptom Scores were recorded.  

The results showed significant clinical improvement after POEM in over 94% of patients after 1 year, EFLIP changed management during the procedure in 5% of patients, extending the myotomy. The post-POEM LES distensibility index (DI) was significantly higher in patients with reflux after 1 year than those without reflux. No significant difference was found in post-POEM LES diameter or change in LES diameter between those with and without reflux.  

They concluded that POEM was a safe and effective therapy for achalasia and that post-procedure reflux was more likely linked to LES-DI than LES diameter.  

Source: journals.lww.com/jcge/abstract/2024/11000/utility_of_intraprocedural_luminal_diameter_and.6.aspx