POEM and Reflux: Less Gastric Myotomy May Be More: GIE | September 2026

What Did the Study Find?

This randomized trial evaluated 100 patients with type I or II achalasia, comparing POEM with a short gastric myotomy (<3 cm) versus extension ≥3 cm.

• Significant reflux esophagitis (LA grade B or greater) occurred in 24% with short vs 44% with longer gastric myotomy.
• This represents an approximately 45% relative reduction in significant reflux esophagitis.
• Clinical efficacy was similar between the two techniques.
• Shorter gastric myotomy was also associated with lower upright esophageal acid exposure.
• Therefore, extending the myotomy further onto the stomach did not provide an apparent efficacy advantage in type I/II achalasia.
• Follow-up was limited to 6 months, and the study was conducted at an experienced high-volume center.

Why Does It Matter?

GERD remains one of POEM’s major limitations. Unlike adding medication or another procedure, shortening gastric myotomy is a simple technical modification during POEM itself.

GastroAGI Takeaway

For type I/II achalasia, more gastric myotomy may mean more reflux—not better efficacy. Keeping gastric extension <3 cm could meaningfully reduce post-POEM reflux esophagitis while preserving treatment success. Longer-term and multicenter validation is needed before defining <3 cm as the universal technical standard.