Work

Management of Recurrent Dysphagia after POEM and Heller Myotomy: Current Strategies and Future Directions

Year: 2026

Type: article

Abstract: PURPOSE OF REVIEW: Dysphagia recurrence after myotomy for achalasia presents a complex clinical challenge. This review highlights causes of recurrent dysphagia, diagnostic strategies, and management options following laparoscopic Heller myotomy (LHM) or per-oral endoscopic myotomy (POEM). RECENT FINDINGS: Both POEM and LHM demonstrate durable efficacy, but recurrence arises from incomplete myotomy, blown-out myotomy (BOM), fundoplication-related obstruction, anatomic esophageal body abnormalities, esophageal dysmotility, or gastroesophageal reflux disease (GERD). In the diagnostic evaluation, functional lumen imaging probe (FLIP) and high-resolution manometry (HRM) provide complementary assessments of esophageal and esophagogastric junction dynamics, while timed barium esophagram (TBE) and endoscopy detect structural issues. Redo myotomy (POEM or LHM), pneumatic dilation (PD), and emerging techniques, such as per-oral plication of the esophagus (POPE), offer targeted therapy with favorable safety and symptom improvement. Recurrent dysphagia is multifactorial, requiring comprehensive esophageal evaluation. Advanced diagnostics and minimally invasive interventions expand therapeutic options, particularly in end-stage disease.

Source: Current Gastroenterology Reports

DOI: 10.1007/s11894-026-01035-4

Authors: Ronald Casey Turner, Anh D. Nguyen, Thomas Tielleman

Institutions: The University of Texas Southwestern Medical Center, Baylor University Medical Center, Baylor Scott & White Research Institute

Language: English

Topic: Gastroesophageal reflux and treatments

Subfield: Gastroenterology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,790