Objective GERD Following POEM Significantly Increased by Length of Myotomy

Ricardo J. Fraticelli Rosado, MD; Mary Michael Evans Shannon, MD; Yassmin Hegazy, MD; Eldrin Bhanat, MD; Venkata
Seerapu, MD; Dylan McClain, MD; Justin Labonte, MD; Jacob R. Moremen, MD University of Mississippi Medical Center —
Jackson, MS, USA Corresponding author: marymichaelevans@gmail.com   Conflicts of Interest: None     Funding:
None

Background:

• GERD is a known complication after per‑oral endoscopic
myotomy (POEM).

• Incidence is well described, but predictors of objective
GERD remain unclear.

• We evaluated endoscopic esophagitis and wireless pH
testing to identify risk factors.

 Methods

Design:

• Retrospective cohort (March 2017–December 2024)

Inclusion:

• Achalasia patients undergoing POEM with follow‑up
EGD and/or Bravo pH ≥6 months

Objective GERD defined as:

• DeMeester >14.72

• Endoscopic esophagitis

Statistics:

• Univariate analysis + Chi‑square

• Multivariable logistic regression

• ROC analysis for discriminatory ability

• Hosmer–Lemeshow for calibration

Conclusions

• Objective GERD occurred in 48% of patients after POEM.

• Myotomy length of 6–7 cm was the only independent predictor.

• ROC analysis confirmed myotomy length as the strongest discriminator.

• BMI, achalasia subtype, DI, Dmin, and operative factors were not predictive.