Peroral endoscopic myotomy for spastic esophageal dysmotility among opioid users: a multicenter propensity score matching study.

Background and Aims: Opioid-induced esophageal dysfunction (OIED) often presents as spastic esophageal disorders (SEDs) and esophagogastric junction outflow obstruction (EGJOO). The aim of this study was to evaluate and compare clinical outcomes of peroral endoscopic myotomy (POEM) for SEDs and EGJOO among opioid users and nonusers.
Methods: This propensity score (PS) matching study included consecutive opioid users and nonusers who underwent POEM for SEDs and EGJOO between January 2018 and September 2022. The following covariates were used for the PS calculation: age, sex, duration of symptoms, Eckardt score, type of motility disorder, and length of myotomy during POEM. Clinical response was defined as a post-POEM Eckardt score ≤3.
Results: A total of 277 consecutive patients underwent POEM during the study period. PS matching resulted in the selection of 64 pairs of patients strictly matched 1:1 (n = 128) with no statistically significant differences in demographic, baseline, or procedural characteristics or in the parameters considered for the PS between the 2 groups. Clinical response to POEM was significantly lower among opioid users (51 of 64 [79.7%]) versus nonusers (60 of 64 [93.8%]) (P = .03) at a median follow-up of 18 months. Among opioid users, higher opioid dose (>60 morphine milligram equivalents per day) was associated with a higher likelihood of failure to respond to POEM (odds ratio, 4.59; 95% confidence interval, 1.31-3.98; P = .02).
Conclusions: Clinical response to POEM for SEDs and EGJOO is significantly lower among opioid users versus nonusers. There was a dose-relationship between opioids and response to POEM, with higher daily opioid usage associated with a higher likelihood of treatment failure.
Competing Interests: Disclosure The following authors disclosed financial relationships: D. Yang: consultant for Olympus, Fujifilm, Apollo Endosurgery, Medtronic, and Microtech; and research support from Microtech and 3D-Matrix. M.K. Hasan: consultant for Boston Scientific and Olympus. P. V. Draganov: consultant for Olympus, Boston Scientific, Fujifilm, Cook Medical, and Medtronic. N. Sharma: consultant for Boston Scientific, Medtronic, Steris, and Olympus. J. H. Hwang: consultant for Boston Scientific, Olympus, Medtronic, Fujifilm, and Microtech. A. Sethi: consultant for Boston Scientific, Interscope, Medtronic, and Olympus; and research support from Boston Scientific and Fujifilm. P. Benias: consultant for Boston Scientific, Apollo Endosurgery, and Fujifilm. P. Kedia: consultant for Boston Scientific, Olympus, and Medtronic. S. Jawaid: consultant for Lumendi, Creo Medical, and ConMed. M. B. Ujiki: member of the advisory board for Boston Scientific and Apollo Endosurgery; and speaker for Gore and Medtronic. R. Kim: consultant for Medtronic, Cook Medical, and Apollo Endosurgery. M. Othman: consultant for Olympus, Boston Scientific, Creo Medical, Apollo Endosurgery, Lumendi, AbbVie, and Nestle; and research support from Boston Scientific, ConMed, Lucid Diagnostic, AbbVie, and Nestle. All other authors disclosed no financial relationships.
(Copyright © 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)