Active narcotic use and post–peroral endoscopic myotomy outcomes in esophageal motility disorders

Abstract

Background and AimsPeroral Endoscopic Myotomy (POEM) is a minimally invasive technique used to treat esophageal motility disorders. Opioid use has been demonstrated to adversely affect esophageal dysmotility and is associated with an increased prevalence of esophageal motility disorders. Our aim was to investigate the effect of narcotic use on success rates in patients undergoing POEM. MethodsThis was a single center retrospective study of patients undergoing POEM between February 2017 and September 2021. Primary outcomes were post-POEM Eckardt Score (ES), Distensibility Index (DI), and length of procedure. Secondary outcomes included technical success, myotomy length, length of stay, adverse events, reintervention rates, post-procedure GERD. ResultsDuring the study period, 90 patients underwent POEM for treatment of esophageal dysmotility disorders. Age, sex, race, indications for POEM, and BMI were not significant between those with or without narcotic use. There were no differences in procedure time, pre-procedure ES, or length of stay. Post-procedure ES were higher in the active narcotic user group compared to the no prior history group (2.73 vs. 1.2, p = .004). Distensibility indices (DI) measured with EndoFLIP were not different in narcotic users compared with opioid naïve subjects. ConclusionActive narcotic use negatively impacts symptom improvement following POEM for treatment of esophageal motility disorders.