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Introduction <p>Peroral endoscopic myotomy (POEM) is an effective and safe treatment for achalasia. However, in some patients symptoms may persist or recur, requiring additional treatment. The aim of this study was to examine the efficacy and safety of performing laparoscopic Heller myotomy (LHM) in achalasia patients having persistent or recurrent symptoms after POEM.</p> Methods <p>This retrospective study includes patients who underwent LHM after they failed on POEM, which was performed between August 2011 and March 2024. Follow-up data were extracted from hospital medical records, and patients completed questionnaires regarding achalasia symptoms and quality of life between March 2024 and August 2025. Primary outcome was treatment success after LHM, defined as Eckardt score ≤ 3 without subsequent retreatment.</p> Results <p>In total, 22 patients were included (median age 43&#xa0;years, 50.0% female) of which 21 completed questionnaires. Median follow-up time after LHM in patients who previously failed on POEM was 86&#xa0;months. Treatment success was observed in three patients (13.6%, <i>n</i> = 3/22), with follow-up of 36, 74 and 110&#xa0;months after LHM. A marked decline in success rate of LHM following POEM was observed over time: approximately 70% after one year and 30% after two years. For patients with treatment failure after LHM, 73.7% required retreatment (<i>n</i> = 14/19), predominantly with pneumatic dilation.</p> Conclusion <p>LHM following POEM yields only minimal benefit with a rapid loss of success over time. These outcomes suggest limited clinical value of LHM following POEM failure and indicate that alternative strategies may be preferable.</p>

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Results of Laparoscopic Heller Myotomy in Achalasia Patients with Persistent or Recurrent Symptoms After Peroral Endoscopic Myotomy (POEM)

  • 期刊论文

  • 发表日期：

    2026年7月22日

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  • Elise M. Wessels,
  • Gwen M. C. Masclee,
  • Marlies P. Schijven,
  • Albert J. Bredenoord

摘要

Introduction

Peroral endoscopic myotomy (POEM) is an effective and safe treatment for achalasia. However, in some patients symptoms may persist or recur, requiring additional treatment. The aim of this study was to examine the efficacy and safety of performing laparoscopic Heller myotomy (LHM) in achalasia patients having persistent or recurrent symptoms after POEM.

Methods

This retrospective study includes patients who underwent LHM after they failed on POEM, which was performed between August 2011 and March 2024. Follow-up data were extracted from hospital medical records, and patients completed questionnaires regarding achalasia symptoms and quality of life between March 2024 and August 2025. Primary outcome was treatment success after LHM, defined as Eckardt score ≤ 3 without subsequent retreatment.

Results

In total, 22 patients were included (median age 43 years, 50.0% female) of which 21 completed questionnaires. Median follow-up time after LHM in patients who previously failed on POEM was 86 months. Treatment success was observed in three patients (13.6%, n = 3/22), with follow-up of 36, 74 and 110 months after LHM. A marked decline in success rate of LHM following POEM was observed over time: approximately 70% after one year and 30% after two years. For patients with treatment failure after LHM, 73.7% required retreatment (n = 14/19), predominantly with pneumatic dilation.

Conclusion

LHM following POEM yields only minimal benefit with a rapid loss of success over time. These outcomes suggest limited clinical value of LHM following POEM failure and indicate that alternative strategies may be preferable.