Clinical outcomes in the implementation of peroral endoscopic myotomy (POEM): Results from the Spanish multicenter registry.

Objective: Peroral endoscopic myotomy (POEM) has emerged as a prominent endoscopic treatment for achalasia and other esophageal motility disorders (EMD). The objective of this study is to evaluate its clinical efficacy and safety after its implementation in Spain.

Patients and methods: This is a multicenter registry conducted across 13 hospitals in Spain. Symptomatic patients undergoing POEM for any EMD were recruited between June 2016 and February 2023. Baseline characteristics, procedural details and outcomes related to efficacy and safety during short and long-term follow-up were analyzed.

Results: A total of 441 patients were enrolled, with type II achalasia representing the most common diagnosis (62.1%). POEM was the primary treatment in 277 patients (62.8%). Clinical success data were available for 396 patients, with a success rate of 94.4% at the last available follow-up (2 years in 117 patients, 1 year in 140, <1 year in 139). A higher baseline Eckardt score was an independent risk factor for clinical failure in the long-term follow-up (p=0.024). Symptomatic reflux occurred in 4.7% of the patients, with a significant esophagitis rate of 11.3%. Complication incidence was 9.3% (41/441), including 14 (3.2%) severe events. Older age (p=0.025) and total procedure duration (p=0.036) were independent risk factors for complications, while mucosal injury was found to be a predictor of severe complications (p=0.027).

Conclusions: These findings confirm the clinical efficacy and safety during the implementation phase of POEM for all EMD in Spain.