6/29/23, 1:41 AM POEM for achalasia Pathway Feedback Search Clinical Topics Home Studies POEM for achalasia POEM for achalasia Disease Achalasia Trial question Is POEM noninferior to laparoscopic Heller's myotomy in patients with idiopathic achalasia? Study design Multi-center Open label RCT Population Characteristics of study participants 42.0% female N = 221 58.0% male 221 patients (93 female, 128 male) Inclusion criteria: patients with symptomatic achalasia Key exclusion criteria: previous surgery of the stomach or esophagus, including surgical therapy of achalasia, diagnosis of secondary achalasia or other organic causes of dysphagia Interventions N=112 POEM (POEM) N=109 laparoscopic Heller's myotomy (LHM) Primary outcome Clinical success at 2 years 83 83.0 % 81 7 https://web.pathway.md/studies/rec4tAU7mcoMDGzmc 1/2 6/29/23, 1:41 AM 83.0 % POEM for achalasia Pathway 83 81.7 62.3 % 41.5 % Difference not exceeding nonferiority margin 20.8 % 0.0 % Peroral endoscopic myotomy Laparoscopic Heller's myotomy Difference not exceeding nonferiority margin in clinical success at 2 years (83% vs. 81.7%; ARD 1.4, 95% CI -8.7 to 11.4) Secondary outcomes Borderline significant increase in reflux esophagitis at 3 months (57% vs. 20%; OR 5.74, 95% CI 2.99 to 11) Safety outcomes No significant differences in serious adverse events (2.7% vs. 7.3%, absolute between-group difference, 4.6 percentage points; 95% CI, 1.1 to 10.4). Conclusion In patients with symptomatic achalasia, POEM was noninferior to laparoscopic Heller's myotomy with respect to clinical success at 2 years. Reference Werner YB, Hakanson B, Martinek J et al. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med. 2019 Dec 5;381(23):2219-2229. Open reference URL https://web.pathway.md/studies/rec4tAU7mcoMDGzmc 2/2