Obesity May Not Affect Success of Peroral Endoscopic Myotomy for Achalasia

Achalasia of the oesophagus. Endoscopic view of a closed sphincter in the oesophagus of a patient affected by achalasia. Achalasia is a failure of smooth muscle fibres to relax, which can cause the lower oesophageal sphincter to remain closed (as here). It can happen at various points along the gastrointestinal tract. Oesophageal achalasia can cause difficulty in swallowing, regurgitation and sometimes chest pain. It often has no underlying cause. Treatment with drugs often causes relief.
Obesity may not affect the success of peroral endoscopic myotomy in patients with achalasia.

According to a study published in the Journal of Clinical Gastroenterology, obesity did not affect the success of peroral endoscopic myotomy (POEM) in patients with achalasia. Of note, the rate of postoperative gastroesophageal reflux disease (GERD) was not higher among patients with obesity compared with patients who were not obese.

Investigators sought to assess the safety and efficacy of POEM in patients who were obese vs nonobese; postsurgical outcomes and incidence of GERD were compared between patient groups.

The study included 89 patients with achalasia who underwent POEM between April 2014 and June 2018; participants were categorized as nonobese (n=46) or obese (n=43). Results of timed barium esophagography and high-resolution esophageal manometry were reported for all participants before and after their POEM procedure. Additionally, demographic and patient characteristics, postoperative pH studies, and Eckardt symptom scores were compared between nonobese and obese groups.

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Between the patient groups, no significant differences in age, gender, ethnicity, achalasia subtype, symptom duration, operative time, length of stay, and complication rates were observed. The rate of success was similar between groups with 97.7% nonobese patients and 92.7% patients with obesity  as measured by Eckardt scores ≤3 (P =.35). Following surgery, parameters of timed barium esophagography and high-resolution esophageal manometry were similar in both treatment groups. In postoperative pH studies, DeMeester scores >14.72 were reported in 58.7% of nonobese patients and 46.5% of patients with obesity (P =.25). Incidence of symptomatic GERD was similarly observed in 17.8% of the nonobese group and 20% of the obese group (P =.79).

Limitations to the study included the short length of follow-up and the single-center retrospective study design. Furthermore, determination of GERD was not based on standardized quality of life questionnaires or evaluation with endoscopy.

The researchers concluded that POEM may be a viable approach for myotomy in patients with obesity.


Sanaka MR, Parikh MP, Subramanium S, et al. Obesity does not impact outcomes or rates of gastroesophageal reflux after peroral endoscopic myotomy in achalasia [published online July 12, 2019]. J Clin Gastroenterol. doi:10.1097/MCG.0000000000001235