Peroral Endoscopic Myotomy For Spastic Esophageal Dysmotility Among Opioid Users: Multicenter Propensity Score Match Study

BACKGROUND AND AIMS:Opioid induced esophageal disorder (OIED) often presents as spastic esophageal disorders (SEDs) and esophagogastric junction outflow obstruction (EGJOO). We aimed to evaluate and compare clinical outcomes of POEM for SEDs and EGJOO among opioid users and non-users. METHODS:Propensity-score (PS) match study of consecutive opioid users and non-users who underwent POEM for SEDs and EGJOO between January 2018 to September 2022. The following covariates were used for PS calculation: age, sex, duration of symptoms, Eckardt score, type of motility disorder, and length of myotomy during POEM. Clinical response was defined as post-POEM Eckardt score ≤3. RESULTS:A total of 277 consecutive patients underwent POEM during the study period. PS match resulted in the selection of 64 pairs of strictly 1:1 matched patients (n=128) with no statistically significant differences in demographics, baseline and procedural characteristics or in the parameters considered for the PS between the two groups. Clinical response to POEM was significantly lower among opioid users (51/64; 79.7%) vs non-users (60/64; 93.8%) (p=0.03) 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 for failure to respond to POEM (Odds Ratio: 4.59; 95% CI: 1.31-3.98; p=0.02). CONCLUSION:Clinical response to POEM for SEDs and EGJOO is significantly lower among opioid users vs. non-users. There was dose-relationship between opioids and response to POEM, with higher daily opioid usage associated with a higher likelihood of treatment failure.