Ultra- Short vs Standard Length oesophageal myotomy in Per-Oral Endoscopic Myotomy: An International Multi-centre Randomised Controlled Trial

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Achalasia is an uncommon disorder of oesophageal motility characterized by failure of relaxation of the Lower Oesophageal Sphincter (LES) resulting in regurgitation of undigested food; chest pain; and weight loss. The mainstay of treatment involves pneumatic dilation, laparoscopic Heller’s myotomy and more recently Per-Oral Endoscopic Myotomy (POEM). Confounders exist in current data comparing oesophageal myotomy length in POEM and optimizing technique. Therefore this study aims to assess myotomy length outcomes. Lay summary: Achalasia is a rare oesophageal disorder where the lower esophageal (feeding tube) sphincter muscle fails to relax, preventing food from entering the stomach properly. The main symptoms are difficulty swallowing (dysphagia), chest pain, and regurgitation of undigested food. It is treated through interventions such as surgery (like Heller myotomy) or endoscopic procedures like balloon dilation or POEM (per oral endoscopic myotomy). Regarding myotomy in particular, a shorter myotomy or cutting of the muscle may result in shorter procedure times. Therefore this study is researching whether this would be a safe approach with similar outcomes to the standard procedure.

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