Heller Myotomy in Patients with Prior Endoscopic Interventions vs the Treatment‑naïve

This retrospective cohort study compares outcomes of Heller myotomy (HM) in 101 patients with prior endoscopic interventions (pneumatic dilation, botulinum toxin, or both) to 101 propensity-matched treatment-naïve patients at Cleveland Clinic (2010–2020).

This study strengthens evidence that HM remains effective regardless of prior endoscopic interventions. Prior endoscopic interventions do not significantly worsen HM outcomes, but subtle trends suggest upfront HM may be preferred when feasible. While statistically insignificant trends hint at reduced emptying and higher reinterventions in pretreated patients, the clinical relevance of these findings warrants further investigation. The work aligns with modern trends favoring minimally invasive HM as a durable option, even after endoscopic failure. POEM offers a less invasive, effective option for achalasia, particularly in complex or refractory cases, with shorter recovery and equivalent short-term outcomes to Heller myotomy. However, Heller myotomy remains preferred for long-term durability and lower reflux rates, especially when combined with Dor fundoplication. Ongoing studies are needed to address POEM’s long-term efficacy and reflux management.

Peer-reviewed by Reza Lankarani M.D