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Introduction <p>Per-oral endoscopic myotomy (POEM) achieves an 80–90% success rate for the treatment of esophageal motility disorders, but approximately 10% of patients experience persistent symptoms. This study evaluated the results of a repeat POEM procedure, or redoPOEM, as a second-line therapy.</p> Methods <p>We conducted a retrospective multicenter study involving 15 French tertiary centers, including all patients undergoing redoPOEM between April 2015 and September 2023. Short and long-term success rates were defined as an Eckardt score &lt; 4 at 3&#xa0;months, and at the last follow-up visit with no need for additional treatment, respectively. Adverse events were graded using the AGREE classification.</p> Results <p>Eighty-seven patients (mean age 56.5&#xa0;years, 57% male) were included; 89.7% had achalasia and 10.3% had non-achalasia motility disorders. The median pre-redoPOEM Eckardt score was 6. The average follow-up duration was 22&#xa0;months. At 3&#xa0;months, 78.2% achieved clinical success (median Eckardt score: 1). Long-term success was obtained in 57.1% at 1&#xa0;year follow-up. Additional treatments were required in 28%. Univariate and multivariate analyses identified a high pre-redoPOEM Eckardt score and prior treatments before POEM as predictors of failure. Adverse events (grade II or higher) occurred in 11.4%, including pneumonia and mucosal breaches, but no deaths were reported.</p> Conclusion <p>RedoPOEM is effective and safe for managing primary failure or symptomatic recurrence after a first POEM. A high pre-redoPOEM Eckardt score and previous treatments are predictive of primary failure. Clinical trials number: NCT06044155.</p> Graphical abstract <p></p>

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RedoPOEM: efficacy and safety after failure of a first POEM for esophageal motility disorders

  • 期刊论文

  • 发表日期：

    2026年1月23日

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  • Amaury D’Angelo,
  • Mathieu Pioche,
  • Maximilien Barret,
  • Jean-Michel Gonzalez,
  • Timothée Wallenhorst,
  • Emmanuel Coron,
  • Guillaume Velut,
  • Geoffroy Vanbiervliet,
  • Philippe Onana Ndong,
  • Jérémie Jacques,
  • Marion Schaefer,
  • Jonathan Levy,
  • Ludovic Caillo,
  • Gabriel Rahmi,
  • Ali Aidibi,
  • Philippe Ah-Soune,
  • Thibault Degand,
  • Maxime Saunier,
  • Frank Zerbib,
  • Arthur Berger

摘要

Introduction

Per-oral endoscopic myotomy (POEM) achieves an 80–90% success rate for the treatment of esophageal motility disorders, but approximately 10% of patients experience persistent symptoms. This study evaluated the results of a repeat POEM procedure, or redoPOEM, as a second-line therapy.

Methods

We conducted a retrospective multicenter study involving 15 French tertiary centers, including all patients undergoing redoPOEM between April 2015 and September 2023. Short and long-term success rates were defined as an Eckardt score < 4 at 3 months, and at the last follow-up visit with no need for additional treatment, respectively. Adverse events were graded using the AGREE classification.

Results

Eighty-seven patients (mean age 56.5 years, 57% male) were included; 89.7% had achalasia and 10.3% had non-achalasia motility disorders. The median pre-redoPOEM Eckardt score was 6. The average follow-up duration was 22 months. At 3 months, 78.2% achieved clinical success (median Eckardt score: 1). Long-term success was obtained in 57.1% at 1 year follow-up. Additional treatments were required in 28%. Univariate and multivariate analyses identified a high pre-redoPOEM Eckardt score and prior treatments before POEM as predictors of failure. Adverse events (grade II or higher) occurred in 11.4%, including pneumonia and mucosal breaches, but no deaths were reported.

Conclusion

RedoPOEM is effective and safe for managing primary failure or symptomatic recurrence after a first POEM. A high pre-redoPOEM Eckardt score and previous treatments are predictive of primary failure. Clinical trials number: NCT06044155.

Graphical abstract