PD03.02. Evolution of POEM Technique With EndoFLIP and Dual-Scope Guidance: Outcomes From a UK Tertiary Centre

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ID: 325740
2026
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Ranked #162 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Benign Disease: Esophageal Function and Motility Background Per-oral endoscopic myotomy (POEM) is an effective minimally invasive treatment for achalasia. EndoFLIP enables real-time assessment of gastro-oesophageal junction distensibility, yet optimal intra-procedural targets remain uncertain. We aimed to evaluate the changes in outcomes in our evolving POEM technique and identify EndoFLIP-guided distensibility thresholds associated with symptom resolution at a tertiary UK centre. Methods A retrospective assessment of patient data was performed on a combination of prospectively collected EndoFLIP data, as well as retrospectively collected patient data. Data collected prospectively included EndoFLIP measurements, pre- and post-operative Eckardt scores, and complications. Patient notes were reviewed for demographics including co-morbidities, American Society of Anaesthesia (ASA) score, type of achalasia, previous interventions, age, gender, myotomy length. Primary outcome measured was incidence of resolution of symptoms at six months, measured as Eckardt score ≤3. Secondary outcomes were relationship between change in distensibility index (DI) and resolution of symptoms, and relationship between previous interventions and changes in DI at 40ml filling. Outcomes between two distinct periods were assessed – 2016-2020, where POEM was performed using EndoFLIP alone, and 2021-2025, where EndoFLIP and dual scope localisation of the gastro-oesophageal junction was combined to assess adequate dissection and myotomy length. Results 157 patients underwent POEM between 2016-2025 – 61 in the first period (2016-2020) and 96 in the second period (2021-2025). Patients in the earlier period had a higher number of previous interventions (50.8% vs 14.7%). Incidence of resolution of symptoms was 93.6% overall, with similar outcomes in the earlier and later periods (94.6% vs 92.9%, p=0.96). Despite this, absolute and relative change in DI was lower in the later cohort (mean absolute change 2.7 vs 1.4, p=0.0001, mean relative change 254.4% vs 184.9%, p=0.044), reflecting a shorter, more precise myotomy as practice evolved. On ROC analysis, there was a strong correlation between change in DI (absolute and relative) and resolution of symptoms (relative change AUC 0.878, absolute change AUC 0.858, p<0.001). When assessing optimal cut-offs, and absolute DI increase at 40mL filling of >1.32 or a relative increase of 152% were found to be the minimum acceptable discriminators for resolution. Conclusion POEM is an effective tool for treatment of achalasia, with a 95% success rate in the appropriately selected patient. This decreases significantly in patients with previous surgical myotomies. Dual scope and EndoFLIP integration into practice has allowed for a more precise myotomy with lower relative changes in DI, whilst maintaining clinical resolution of symptoms. Recommended targets of relative DI change should be at least 150% greater than pre-POEM DI.
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Authors Ashraf Tokhi, Saif Ali, James Catton
Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.088
URL
https://doi.org/10.1093/dote/doag077.088
Keywords Keywords not found

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