Trans-segmental POEM in the management of esophageal asymmetry in achalasia: short outcomes from a retrospective, single-center study

1. Background and study aims: Esophageal asymmetry has been observed in some patients with achalasia, presenting as functional or structural alterations. This study aims to report a single-center experience with the trans-segmental peroral endoscopic myotomy (T-POEM) procedure for the management of esophageal asymmetry in achalasia. 2. Patients and methods: 22 patients with achalasia and severe dysphagia were included. Esophageal asymmetry and restrictive segments were assessed using the Eckardt score, HRM, barium esophagography, CT, EUS, and endoscopy. T-POEM was performed with targeted myotomy of tortuous segments, areas of localized muscular thickening, and localized restrictive muscular segments. This study evaluated the technical feasibility, safety, and observed short-term outcomes of T-POEM. 3.