{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:25:33Z","timestamp":1786944333623,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peroral endoscopic myotomy (POEM) is an established treatment for achalasia, achieving &gt;90% short\u2010term clinical success. However, long\u2010term durability remains less clear. This study evaluates POEM outcomes beyond 5\u2009years in a multi\u2010centre cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study evaluates POEM outcomes beyond 5 years in a multi\u2010centre cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with achalasia who underwent POEM across four Australian tertiary centres (January 2014\u2013January 2020) were prospectively enrolled. Eckardt scores were recorded pre\u2010treatment and at multiple intervals up to \u22655\u2009years after POEM. Primary outcome was clinical success at \u22655\u2009years, defined as Eckardt score \u22643 without need for re\u2010intervention. Secondary outcomes included risk factors for failure and management strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 221 eligible patients, 153 (69.2%) had \u22655\u2010year follow\u2010up data available, with median follow\u2010up of 6.5\u2009years (interquartile range (IQR) 5.6\u20137.6). Achalasia subtypes included type I (23.5%), type II (62.1%) and type III (14.4%). Among the patients, 52.3% were treatment\u2010na\u00efve; prior therapies included laparoscopic Heller myotomy (14.3%), botulinum toxin (17.0%) and pneumatic balloon dilation (30.7%). Clinical success at \u22655\u2009years was observed in 118 (77.1%) patients. Median Eckardt scores improved from 8.0 (IQR 6.0\u201310.0) before POEM to 0.0 (IQR 0.0\u20131.0) at 3\u20136 months, 1.0 (IQR 0.0\u20132.0) at 2\u2009years and 2.0 (IQR 0.0\u20133.0) at 5\u2009years. Sustained success was associated with lower baseline Eckardt scores (\n                      <jats:italic>P<\/jats:italic>\n                      =\u20090.033). Prior lower oesophageal sphincter (LOS)\u2010directed therapy predicted failure (odds ratio 3.80,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;\u20090.001). Age, achalasia subtype, myotomy characteristics and post\u2010POEM endoscopy findings were not predictive.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>POEM provides durable symptom relief beyond 5\u2009years for achalasia. Higher pre\u2010POEM symptom burden and prior LOS\u2010directed interventions are associated with reduced long\u2010term success.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/imj.70609","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:09:59Z","timestamp":1786943399000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sustained clinical outcomes at long\u2010term follow\u2010up after peroral endoscopic myotomy for achalasia: a multicentre cohort study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4087-4998","authenticated-orcid":false,"given":"Varan","family":"Perananthan","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Westmead Hospital  Sydney New South Wales Australia"},{"name":"Westmead Clinical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2734-9347","authenticated-orcid":false,"given":"Lucy","family":"Bracken","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Westmead Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Princess Alexandra Hospital  Brisbane Queensland Australia"},{"name":"Gallipoli Medical Research Institute, School of Medicine The University of Queensland, Greenslopes Private Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology St Vincent's Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9931-7221","authenticated-orcid":false,"given":"Francesco Vito","family":"Mandarino","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Westmead Hospital  Sydney New South Wales Australia"},{"name":"Westmead Clinical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Westmead Hospital  Sydney New South Wales Australia"},{"name":"Westmead Clinical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Gauci","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Westmead Hospital  Sydney New South Wales Australia"},{"name":"Westmead Clinical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clarence","family":"Kerrison","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Westmead Hospital  Sydney New South Wales Australia"},{"name":"Westmead Clinical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3471-8304","authenticated-orcid":false,"given":"Sunil","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Westmead Hospital  Sydney New South Wales Australia"},{"name":"Westmead Clinical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Whitfield","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Westmead Hospital  Sydney New South Wales Australia"},{"name":"Westmead Clinical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4434-1627","authenticated-orcid":false,"given":"Nicholas","family":"Burgess","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Westmead Hospital  Sydney New South Wales Australia"},{"name":"Westmead Clinical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1524-3086","authenticated-orcid":false,"given":"Spiro","family":"Raftopoulos","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Sir Charles Gairdner Hospital  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bronte A.","family":"Holt","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology St Vincent's Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke F.","family":"Hourigan","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Princess Alexandra Hospital  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Bourke","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Westmead Hospital  Sydney New South Wales Australia"},{"name":"Westmead Clinical School University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/s41572-022-00356-8","article-title":"Achalasia","volume":"8","author":"Savarino E","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.14309\/ajg.0000000000000731","article-title":"ACG clinical guidelines: diagnosis and management of achalasia","volume":"115","author":"Vaezi MF","year":"2020","journal-title":"Am J Gastroenterol"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.gie.2019.04.231","article-title":"ASGE guideline on the management of achalasia","volume":"91","author":"Khashab MA","year":"2020","journal-title":"Gastrointest Endosc"},{"key":"e_1_2_7_5_1","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.1056\/NEJMoa1905380","article-title":"Endoscopic or surgical myotomy in patients with idiopathic achalasia","volume":"381","author":"Werner YB","year":"2019","journal-title":"N Engl J Med"},{"key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.gie.2022.03.004","article-title":"Evolution and evidence\u2010based adaptations in techniques for peroral endoscopic myotomy for achalasia","volume":"96","author":"Hasan A","year":"2022","journal-title":"Gastrointest Endosc"},{"key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s10620-019-05784-3","article-title":"Updated systematic review of achalasia, with a focus on POEM therapy","volume":"65","author":"Cappell MS","year":"2020","journal-title":"Dig Dis Sci"},{"key":"e_1_2_7_8_1","doi-asserted-by":"crossref","first-page":"2444","DOI":"10.1016\/j.cgh.2022.05.040","article-title":"POEM and GERD: prevalence, mechanisms, potential strategies for prevention, and management","volume":"20","author":"Ravi K","year":"2022","journal-title":"Clin Gastroenterol Hepatol"},{"key":"e_1_2_7_9_1","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1001\/jama.2019.8859","article-title":"Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment\u2010naive patients with achalasia: a randomized clinical trial","volume":"322","author":"Ponds FA","year":"2019","journal-title":"JAMA"},{"key":"e_1_2_7_10_1","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/j.gie.2019.11.020","article-title":"Peroral endoscopic myotomy for achalasia: a prospective multicenter study in Japan","volume":"91","author":"Shiwaku H","year":"2020","journal-title":"Gastrointest Endosc"},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.gie.2024.09.027","article-title":"Long\u2010term clinical evaluation of a decade with peroral endoscopic myotomy at a single European tertiary center","volume":"101","author":"Vackova Z","year":"2024","journal-title":"Gastrointest Endosc"},{"key":"e_1_2_7_12_1","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/j.gie.2021.05.014","article-title":"Peroral endoscopic myotomy: 10\u2010year outcomes from a large, single\u2010center U.S. series with high follow\u2010up completion and comprehensive analysis of long\u2010term efficacy, safety, objective GERD, and endoscopic functional luminal assessment","volume":"94","author":"Modayil RJ","year":"2021","journal-title":"Gastrointest Endosc"},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1055\/a-1894-0147","article-title":"Long\u2010term outcomes of peroral endoscopic myotomy for achalasia: a systematic review and meta\u2010analysis","volume":"55","author":"Vespa E","year":"2023","journal-title":"Endoscopy"},{"key":"e_1_2_7_14_1","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/MCG.0000000000001776","article-title":"Long\u2010term outcome of peroral endoscopic myotomy in esophageal motility disorders: a systematic review and meta\u2010analysis","volume":"57","author":"Nabi Z","year":"2023","journal-title":"J Clin Gastroenterol"},{"key":"e_1_2_7_15_1","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1016\/0016-5085(92)91428-7","article-title":"Predictors of outcome in patients with achalasia treated by pneumatic dilation","volume":"103","author":"Eckardt VF","year":"1992","journal-title":"Gastroenterology"},{"key":"e_1_2_7_16_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.5694\/mja2.50941","article-title":"A prospective multicentre study of per\u2010oral endoscopic myotomy (POEM) for achalasia in Australia","volume":"214","author":"Gupta S","year":"2021","journal-title":"Med J Aust"},{"key":"e_1_2_7_17_1","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1136\/gut.45.2.172","article-title":"Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification","volume":"45","author":"Lundell LR","year":"1999","journal-title":"Gut"},{"key":"e_1_2_7_18_1","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/S2468-1253(25)00012-3","article-title":"Per\u2010oral endoscopic myotomy versus laparoscopic Heller's myotomy plus Dor fundoplication in patients with idiopathic achalasia: 5\u2010year follow\u2010up of a multicentre, randomised, open\u2010label, non\u2010inferiority trial","volume":"10","author":"Hugova K","year":"2025","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"e_1_2_7_19_1","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.gie.2023.10.025","article-title":"Factors associated with early failure of peroral endoscopic myotomy in achalasia","volume":"99","author":"Vauquelin B","year":"2024","journal-title":"Gastrointest Endosc"},{"key":"e_1_2_7_20_1","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/j.gie.2017.10.031","article-title":"Outcomes of per\u2010oral endoscopic myotomy for treatment of esophageal achalasia with a median follow\u2010up of 49 months","volume":"87","author":"Li QL","year":"2018","journal-title":"Gastrointest Endosc"},{"key":"e_1_2_7_21_1","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1016\/j.cgh.2017.01.031","article-title":"Efficacy and safety of peroral endoscopic myotomy for treatment of achalasia after failed heller myotomy","volume":"15","author":"Ngamruengphong S","year":"2017","journal-title":"Clin Gastroenterol Hepatol"},{"key":"e_1_2_7_22_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.gie.2023.01.052","article-title":"Comparing clinical success and procedural difficulty between treatment\u2010naive and treatment\u2010refractory patients with esophageal motility disorders during peroral endoscopic myotomy","volume":"98","author":"Kadiyala J","year":"2023","journal-title":"Gastrointest Endosc"},{"key":"e_1_2_7_23_1","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1055\/a-1312-0496","article-title":"Management of patients after failed peroral endoscopic myotomy: a multicenter study","volume":"53","author":"Ichkhanian Y","year":"2021","journal-title":"Endoscopy"},{"key":"e_1_2_7_24_1","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1053\/j.gastro.2017.10.001","article-title":"Clinical practice update: the use of per\u2010oral endoscopic myotomy in achalasia: expert review and best practice advice from the AGA Institute","volume":"153","author":"Kahrilas PJ","year":"2017","journal-title":"Gastroenterology"},{"key":"e_1_2_7_25_1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/nmo.12711","article-title":"Histopathologic patterns among achalasia subtypes","volume":"28","author":"Sodikoff JB","year":"2016","journal-title":"Neurogastroenterol Motil"},{"key":"e_1_2_7_26_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.gie.2017.04.036","article-title":"Management of recurrent symptoms after per\u2010oral endoscopic myotomy in achalasia","volume":"87","author":"Hoeij FB","year":"2018","journal-title":"Gastrointest Endosc"},{"key":"e_1_2_7_27_1","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1055\/a-1133-4354","article-title":"Gastroesophageal reflux disease after peroral endoscopic myotomy is unpredictable, but responsive to proton pump inhibitor therapy: a large, single\u2010center study","volume":"52","author":"Nabi Z","year":"2020","journal-title":"Endoscopy"},{"key":"e_1_2_7_28_1","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1055\/a-1753-9801","article-title":"Risk factors and long\u2010term course of gastroesophageal reflux disease after peroral endoscopic myotomy: a large\u2010scale multicenter cohort study in Japan","volume":"54","author":"Shiwaku H","year":"2022","journal-title":"Endoscopy"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70609","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/imj.70609","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70609","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:10:03Z","timestamp":1786943403000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.70609"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,16]]},"references-count":27,"alternative-id":["10.1111\/imj.70609"],"URL":"https:\/\/doi.org\/10.1111\/imj.70609","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,16]]},"assertion":[{"value":"2026-04-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"imj.70609"}}