Achalasia is characterized by impaired relaxation of the LES and loss of esophageal peristalsis. Treatment options include pneumatic dilation, botulinum toxin injection, and surgical myotomy. POEM has emerged as a less invasive endoscopic alternative. This study evaluates the intermediate and long-term outcomes of POEM in a cohort of Iranian patients with achalasia resistant to conventional dilation therapy.

Study Design and Patients: A prospective cohort study was conducted at Shariati Hospital, Tehran. Twenty-one patients with persistent symptoms after pneumatic dilation were enrolled. Diagnosis was confirmed using endoscopy, timed barium esophagogram, and high-resolution manometry. Intervention: POEM was performed under general anesthesia. A mucosal incision was made, a submucosal tunnel created, and myotomy of the circular muscle layer extended 2 cm into the stomach. Outcome Measures: The ASS was used to evaluate symptoms at baseline, 1, 3, and 12 months postoperatively. Treatment success was defined as an ASS ≤ 4. Statistical Analysis: Data were analyzed using appropriate non-parametric tests. A p-value < 0.05 was considered significant.

The study included 21 patients (9 male, 12 female), mean age 40.67 years. The mean ASS decreased significantly one month after POEM (p < 0.0001). However, scores increased at 3 and 12 months. Although 73.7% of patients initially responded, over half experienced recurrence within one year. Age and gender did not significantly influence outcomes.

POEM provides significant short-term symptom improvement in achalasia patients, consistent with previous studies. However, the declining efficacy over time highlights the need for long-term monitoring and possibly re-intervention. The high recurrence rate may be attributed to disease chronicity or technical factors. POEM remains a safe and effective less invasive option compared to surgical myotomy. POEM is an effective initial treatment for achalasia, particularly in dilation-resistant cases. Long-term follow-up is essential due to the risk of symptom recurrence. Future studies should include objective measures such as LES pressure and standardized reflux evaluation