Beth Israel Lahey Hospital and Medical Center Burlington, MA
Muhammad Ali Butt, MD1, Babak Mirminachi, MD2, Lizeth Cifuentes, MD3, Thomas Gonzales, MD3, Joo Ha. Hwang, MD4, Andrew Li, MD4, Alexander Schlachterman, MD5, Mohammad Al-Haddad, MD6, Shyam Thakkar, MD7, Sunil Amin, MD, MPH8, Abel Joseph, MD9, Walli Ansari, 10, Jayati Anand, MD5, Yervant Ichkhanian, MD6, George Obeng, MD7, Sultan Mahmood, MD3 1Beth Israel Lahey Hospital and Medical Center, Burlington, MA; 2University of Pittsburgh Medical Center, Harrisburg, PA; 3University of Pittsburgh Medical Center, Pittsburgh, PA; 4Stanford University, Stanford, CA; 5Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; 6Indiana University School of Medicine, Indianapolis, IN; 7West Virginia University, Morgantown, WV; 8University of Miami Health System, Miami, FL; 9Stanford University, Redwood City, CA; 10Thomas Jefferson University Hospital, Philadelphia, PA Introduction: Achalasia affects about 10.8 per 100,000 individuals; its coexistence with cirrhosis remains undocumented. Portal hypertension and coagulopathy in cirrhosis pose bleeding and healing risks during peroral endoscopic myotomy (E-POEM). We conducted a multicenter retrospective study to assess E-POEM’s feasibility, technical success, outcomes, and safety in achalasia patients with cirrhosis. Methods: From 2020 to 2024, we retrospectively reviewed achalasia patients with cirrhosis undergoing E-POEM at six U.S. tertiary centers. We recorded demographics, cirrhosis etiology, variceal grade, procedural metrics, including myotomy length, orientation, tunnel extensions, and hospital stay. Continuous variables are presented as mean ± SD. The primary endpoint was technical success (completed myotomy without conversion or major bleeding); secondary endpoints included clinical success (Eckardt score ≤ 3 at six months) and adverse events. Results: Twenty-four patients (mean age 67.5 ± 10.4 years; 10 females) underwent E-POEM. Etiologies included nonalcoholic steatohepatitis (n = 10), alcohol-related liver disease (n = 7) and viral hepatitis (n = 3). Mean MELD was 11.9 ± 6.2; 13 patients were Child–Pugh class A and 11 class B; 67% had prior decompensation. Baseline Eckardt score averaged 7.6 ± 2.1. All myotomies were successful; a posterior approach was used in 21 patients. Mean myotomy length was 11.4 ± 4.4 cm, extending 2.2 cm beyond the gastroesophageal junction; mean procedure time was 76.3 ± 37.9 minutes; mean hospital stay was 2.5 ± 4.2 days. Mean follow-up was 12.7 ± 7.6 months. One patient developed transient chest pain; four had extended stays for unrelated conditions. No variceal bleeds or transfusions occurred. Follow-up Eckardt scores were available for 21 patients, of whom 18 (85.7%) achieved clinical success. Discussion: E-POEM is safe and effective in achalasia patients with compensated cirrhosis. These findings support its use in this high-risk group, but larger prospective studies are needed to confirm durability and refine selection criteria.
Figure: Table 1- Clinical characteristics of Cirrhotic Patients Undergoing Esophageal Peroral Endoscopic Myotomy (E-POEM) for Refractory Gastroparesis
Figure: Table 2- Participating Institutions and Number of Patients at Each Center
Disclosures: Muhammad Ali Butt indicated no relevant financial relationships. Babak Mirminachi indicated no relevant financial relationships. Lizeth Cifuentes indicated no relevant financial relationships. Thomas Gonzales indicated no relevant financial relationships. Joo Hwang indicated no relevant financial relationships. Andrew Li indicated no relevant financial relationships. Alexander Schlachterman: Boston Scientific – Consultant. FujiFilm – Consultant. Laborie – Consultant. Lumendi – Consultant. Microtech – Consultant. Olympus – Consultant. Mohammad Al-Haddad: Amplified Sciences – Grant/Research Support. Boston Scientific – Consultant. Interpace diagnostics – Consultant. Shyam Thakkar indicated no relevant financial relationships. Sunil Amin: 3D Matrix – Consultant. Boston Scientific – Consultant. Medtronic – Consultant. Abel Joseph indicated no relevant financial relationships. Walli Ansari indicated no relevant financial relationships. Jayati Anand indicated no relevant financial relationships. Yervant Ichkhanian indicated no relevant financial relationships. George Obeng indicated no relevant financial relationships. Sultan Mahmood indicated no relevant financial relationships.
Muhammad Ali Butt, MD1, Babak Mirminachi, MD2, Lizeth Cifuentes, MD3, Thomas Gonzales, MD3, Joo Ha. Hwang, MD4, Andrew Li, MD4, Alexander Schlachterman, MD5, Mohammad Al-Haddad, MD6, Shyam Thakkar, MD7, Sunil Amin, MD, MPH8, Abel Joseph, MD9, Walli Ansari, 10, Jayati Anand, MD5, Yervant Ichkhanian, MD6, George Obeng, MD7, Sultan Mahmood, MD3. P1389 - Efficacy and Safety of Esophageal Peroral Endoscopic Myotomy (E-POEM) in Achalasia Patients With Cirrhosis: A Multicenter Study, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
