Role of postoperative endoscopy after peroral endoscopic myotomy: Evidence from a large cohort study

doi:10.3748/wjg.122272

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Dec 21, 2026; 32(47): 122272
Published online Dec 21, 2026. doi: 10.3748/wjg.122272

Role of postoperative endoscopy after peroral endoscopic myotomy: Evidence from a large cohort study

Carolin Kastner, Malika Aktanova, Lars Kollmann, Alexandra Marschalek, Friederike Meyer, Jana Anger, Ilona Flemming, Jakob Lauerer, Alexander Weich, Markus Brand, Alexander Hann, Burkard HA von Rahden, Sven Flemming, Christoph-Thomas Germer, Florian Seyfried

Carolin Kastner, Malika Aktanova, Lars Kollmann, Alexandra Marschalek, Friederike Meyer, Jana Anger, Ilona Flemming, Jakob Lauerer, Sven Flemming, Christoph-Thomas Germer, Florian Seyfried, Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg 97080, Germany

Alexander Weich, Markus Brand, Alexander Hann, Department of Gastroenterology, Internal Medicine II, University Hospital Wuerzburg, Wuerzburg 97080, Germany

Burkard HA von Rahden, Division of Upper Gastrointestinal Surgery, Department of Surgery, University Hospital Salzburg, Salzburg 5020, Austria

Author contributions: Seyfried F and Kastner C participated in the conception and design of the study and were involved in the acquisition, analysis, and interpretation of the data; Kollmann L contributed to the study concept and design and supervised the patient data collection; Aktanova M, Meyer F, Marschalek A, and Lauerer J collected the patient’s clinical data; Kastner C and Seyfried F drafted the manuscript; Kastner C, Aktanova M, Kollmann L, Marschalek A, Meyer F, Anger J, Flemming I, Lauerer J, Weich A, Brand M, Hann A, von Rahden BHA, Flemming S, Germer CT, and Seyfried F critically reviewed the manuscript, approved the final version, and were responsible for the decision to submit the manuscript for publication.

AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript. AI tools were not used for hypothesis generation, data collection, statistical analyses, generation of original scientific data, or the drawing of scientific conclusions. Generative AI (ChatGPT) was used exclusively for linguistic refinement, including improvement of readability, phrasing, word reduction, and paraphrasing of selected manuscript sections, particularly the abstract. All AI-assisted outputs were critically and carefully reviewed, validated, and approved by the authors.

Institutional review board statement: This study was approved by the Institutional Review Board of the University of Wuerzburg (No. 2025-159 1-dvha).

Informed consent statement: The requirement for study-specific informed consent was waived because of the retrospective study design.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.

Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available owing to ethical and data protection restrictions. However, anonymized data may be made available from the corresponding author upon reasonable request and after approval by the local ethics committee. Requests should be addressed to: Florian Seyfried, seyfried_f@ukw.de.

Corresponding author: Florian Seyfried, MD, Department of General, Visceral, Transplantation, Vascular, and Pediatric Surgery, University Hospital Wuerzburg, Oberdürrbacherstraße 6, Wuerzburg 97080, Germany. seyfried_f@ukw.de

Received: April 14, 2026
Revised: June 5, 2026
Accepted: July 3, 2026
Published online: December 21, 2026
Processing time: 196 Days and 9.9 Hours

Abstract

BACKGROUND

Although the efficacy and safety of peroral endoscopic myotomy (POEM) are well established, evidence guiding optimal perioperative management remains limited. In particular, current international guideline recommendations regarding the role of programmed postoperative endoscopy offer limited procedural guidance and are supported by a restricted evidence base.

AIM

To identify risk factors for adverse events and complications following POEM and to evaluate the clinical value of postoperative endoscopy.

METHODS

This retrospective single-center study included 417 patients with achalasia or other primary esophageal motility disorders who underwent POEM at a tertiary care academic center (January 2013 to May 2025), using a prospectively maintained clinical database. Primary outcomes were intraoperative adverse events, pathological findings in postoperative endoscopy, and postoperative complications. Independent risk factors for intraoperative adverse events and pathological endoscopic findings were assessed using univariable and multivariable logistic regression. The number needed to screen (NNS) was calculated for programmed and risk-based postoperative endoscopy.

RESULTS

Intraoperative adverse events, predominantly mucosal injury (3.1%) and submucosal bleeding (3.8%), occurred in 10.1% of patients. Pathological findings requiring intervention were detected in 1.7% of programmed postoperative endoscopies. Overall, 3.1% of patients developed postoperative complications (Clavien-Dindo grade IIIa-IVb), of which 76.9% were (sub)mucosa-related. Obesity, myotomy length, and myotomy rate (minute/cm) were identified as independent risk factors for intraoperative adverse events. Adverse event rates declined in parallel with marked improvements in operative efficiency over time. Intraoperative adverse events predicted abnormal findings on programmed postoperative endoscopy. Risk-based endoscopic stratification reduced the NNS from 49.3 to 14 for findings requiring intervention.

CONCLUSION

Intraoperative adverse events during POEM predict pathological findings on programmed postoperative endoscopy. A risk-adapted postoperative endoscopy strategy maintains patient safety while substantially reducing unnecessary interventions.

Keywords: Achalasia; Peroral endoscopic myotomy; Adverse events; Postoperative endoscopy; Perioperative care

Core Tip: Although peroral endoscopic myotomy (POEM) is an established treatment for achalasia, evidence guiding optimal perioperative management remains limited. In this large single-center cohort of 417 patients, we identified independent risk factors for intraoperative adverse events and pathological findings in postoperative endoscopy following POEM. Risk stratification based on these factors substantially reduced the number needed to screen for clinically relevant endoscopic findings requiring intervention. These data provide evidence-based guidance for individualized perioperative management after POEM and support a selective, risk-adapted postoperative endoscopic strategy that preserves patient safety while reducing unnecessary procedures.