Factors associated with early failure of peroral endoscopic myotomy in achalasia

Background and aims: Achalasia can be treated very effectively with peroral endoscopic myotomy (POEM), but factors associated with early failure remain to be determined, especially in European cohorts. Methods: All consecutive adult patients who underwent a first POEM to treat primary achalasia were included in this multicenter retrospective study. Early failure was defined by an Eckardt score (ES) >3 at 3 months after POEM. When evaluating factors predictive of early failure, 2 cohorts were considered: one consisted of the total population, for whom only basic variables were collected, and the other a cohort built for a case -control study that included matched early -failure and early -success patients (ratio, 1:2). Results: Among 746 patients, the early failure rate was 9.4%. Predictive factors were age <45 years (P = .019), achalasia types I and III (P < .001), and the development of a severe adverse event during the procedure (P = .023). In the case -control study, the only additional independent risk factor for early failure was a high pre -POEM ES (P = .001). Only the retrosternal pain subscore was significantly associated with the early failure rate. Conclusion: The early failure rate of POEM used to treat primary achalasia is <10%. Younger age, type I/III achalasia, and a high pre -POEM ES were significantly associated with failure. (Gastrointest Endosc 2024;99:349-57.)