Background and Aim: Peroral endoscopic myotomy (POEM) is an established therapy for achalasia. There are limited data pertaining to the efficacy of POEM for hypercontractile esophageal disorders, including jackhammer esophagus and diffuse esophageal spasm. We aimed to investigate the efficacy and safety of POEM for the management of hypercontractile esophageal disorders.

Methods: We conducted a prospective multicenter observational study of patients who underwent POEM for an esophageal motility disease. Eckardt scores were calculated before POEM and at 6 months, 1 year, and 2 years after POEM. The primary outcome was clinical success, defined as an Eckardt score ≤3 without reintervention.

Results: A total of 369 patients underwent POEM in three Australian tertiary centers between 2015 and 2021. Of these, 361 had achalasia and eight had a hypercontractile esophageal disorder (six with jackhammer esophagus and two with diffuse esophageal spasm). In the hypercontractile esophageal disorder cohort, the median pre-POEM Eckardt score was 6.0 (IQR, 4.25–9.00; Fig. 1). At 6 months after POEM, the median Eckardt score was 1.0 (IQR, 0.00–1.00; P < 0.001). At 2 years after POEM, the median Eckardt score was 1.00 (IQR, 0.00–2.25), which remained significantly lower than the pre-POEM median Eckardt score (P < 0.001). An excellent clinical response was achieved in all eight patients (100%) at 2 years after POEM without need for reintervention. Prior treatment, including balloon dilatation (n = 4, 50%), botulinum toxin injection (n = 2, 25%), or Heller's myotomy (n = 1, 12.5%) did not affect outcomes. One patient (12.5%) experienced an adverse event, with a pleural effusion requiring drainage. The patient recovered during the same hospital stay, without long-term sequelae. The median length of stay was 2.0 days (IQR, 1.0–3.0). Conclusion: POEM is effective for hypercontractile esophageal disorders, with all patients achieving clinical success at 6 months, which was sustained at 2 years.