Impact of gastric length of myotomy during POEM on the incidence of gastroesophageal reflux: A randomized controlled trial
Abstract
BACKGROUND AND AIMS
Peroral endoscopic myotomy (POEM) is an effective treatment for achalasia cardia, but gastroesophageal reflux disease (GERD) remains a significant concern. The length of gastric myotomy may influence reflux outcomes, but high-quality data are lacking. This randomized controlled trial compared the incidence of GERD after short versus long gastric myotomy (SGM vs LGM) during POEM.
METHODS
In this randomized trial, we compared SGM (gastric myotomy <3 cm) with LGM (gastric myotomy≥3 cm) during POEM in cases with type I or II achalasia. The primary endpoint was significant reflux esophagitis defined as Los Angeles (LA) grade B or higher esophagitis at 6 months follow-up. Secondary endpoints included esophageal acid exposure (≥6% total acid exposure time [AET]) on 24-hour pH monitoring, reflux symptoms, proton pump inhibitor (PPI) use, Eckardt score, esophageal emptying, and high-resolution manometry parameters.
RESULTS
A total of 100 patients were randomly assigned to undergo either POEM with SGM (50 patients) or LGM (50 patients). Baseline characteristics were similar between groups. At 6 months, significant reflux esophagitis occurred in 24% (12/50) of SGM patients versus 44% (22/50) of LGM patients (p = 0.035; odds ratio, 2.45; 95% CI, 1.04-5.79). Upright acid exposure was significantly lower in the SGM group (median 0.75% vs 3.2%; p = 0.036). No differences were observed in reflux symptoms, PPI use, total AET, or clinical efficacy between groups.…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 100 participants or records.
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