Per oral endoscopic
myotomy (POEM) is a safe and effective treatment for
esophageal motility disorder in treatment-naïve patients as well as
salvage therapy. Though type II
achalasia, compared to other subtypes, is reported to have a more favorable outcome with pneumatic dilation (PD) or
Heller myotomy (HM), it is unclear whether
achalasia subtype predicts symptom response to POEM. We aimed to evaluate whether type II
achalasia is associated with a comparably favorable outcome following POEM. We performed a retrospective review of patients with
esophageal motility disorder who were referred for POEM from April 2014 to June 2017. The main outcome was clinical success based on Eckardt score ≤3 and its association with subtype and safety. A total of 63 patients (mean age 51 years [SD 15]; 63% male) underwent a total of 68 POEMs with median of 263 days follow-up. Of these, 45 (71.3%) patients were type II
achalasia. In all, 29 (46%) patients were treatment-naïve and 34 (54%) patients had previous endoscopic or surgical
therapy including
botulinum toxin injection in 16 (25%), PD in 10 (16%), both
botulinum toxin injection and PD in 8 (13%) and HM in 3 (5%). Technical success was 100% and clinical success was achieved in 51 (81%) patients. The rate of clinical success was higher in patients with type II
achalasia compared to the other subtypes (88.9% vs. 61.1% [P = 0.028]) and type II
achalasia patients required fewer redo POEM (2.2% vs. 22.2% [P = 0.021]). Multivariate logistic regression analysis demonstrated the positive prediction of clinical success for type II
achalasia following POEM (P = 0.046). As observed with PD and HM, type II
achalasia was associated with a favorable clinical outcome following POEM.