Impact of gastric length of myotomy during POEM on the incidence of gastroesophageal reflux: A randomized controlled trial
In brief
Short gastric myotomy cuts significant reflux esophagitis by about half after POEM
In a randomized trial of 100 achalasia patients, those receiving a gastric myotomy shorter than 3 cm developed LA grade B or higher esophagitis in 24% versus 44% with longer cuts, while symptom scores and treatment success were similar. The finding suggests a shorter myotomy may lower endoscopic reflux risk without compromising efficacy, but longer follow-up is needed.
- Journal
- Gastrointestinal endoscopy (Q1)
- Published
- 18 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Zaheer Nabi, Naveen Adepu, Pradev Inavolu, Jayanta Samanta, Hardik Rughwani, Aniruddha Pratap Singh, et al.
- PMID
- 42759727
- DOI
- 10.1016/j.gie.2026.09.018
Why clinicians should know about it
- Picked for Gastroenterology (top studies of the week, 20 September 2026): RCT comparing gastric myotomy length in POEM
Abstract
BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is an effective treatment for achalasia cardia, but gastroesophageal reflux disease (GERD) remains a significant concern. The length of gastric myotomy may influence reflux outcomes, but high-quality data are lacking. This randomized controlled trial compared the incidence of GERD after short versus long gastric myotomy (SGM vs LGM) during POEM. METHODS: In this randomized trial, we compared SGM (gastric myotomy <3 cm) with LGM (gastric myotomy≥3 cm) during POEM in cases with type I or II achalasia. The primary endpoint was significant reflux esophagitis defined as Los Angeles (LA) grade B or higher esophagitis at 6 months follow-up. Secondary endpoints included esophageal acid exposure (≥6% total acid exposure time [AET]) on 24-hour pH monitoring, reflux symptoms, proton pump inhibitor (PPI) use, Eckardt score, esophageal emptying, and high-resolution manometry parameters. RESULTS: A total of 100 patients were randomly assigned to undergo either POEM with SGM (50 patients) or LGM (50 patients). Baseline characteristics were similar between groups. At 6 months, significant reflux esophagitis occurred in 24% (12/50) of SGM patients versus 44% (22/50) of LGM patients (p = 0.035; odds ratio, 2.45; 95% CI, 1.04-5.79). Upright acid exposure was significantly lower in the SGM group (median 0.75% vs 3.2%; p = 0.036). No differences were observed in reflux symptoms, PPI use, total AET, or clinical efficacy between groups. CONCLUSIONS: SGM significantly reduces the incidence of LA grade ≥B esophagitis at 6 months following POEM, without differences in symptom burden, acid exposure, or clinical efficacy. (ClinicalTrials.gov number, NCT05500196).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.