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This randomized clinical trial directly compared peroral endoscopic myotomy (POEM) with pneumatic dilation in treatment-naive patients with achalasia. POEM produced greater improvement in symptom severity and a substantially higher rate of treatment success at the primary follow-up point. The study helped establish POEM as a major endoscopic option for achalasia rather than simply an experimental alternative. Its significance for surgeons and interventional endoscopists is that the therapeutic landscape for esophageal motility disorders now includes procedures that can achieve a myotomy without the external incisions required for traditional surgery. At the same time, the trial highlights an important trade-off: gastroesophageal reflux and reflux-related esophageal acid exposure can occur after POEM, so patients need appropriate counseling and follow-up. The choice among POEM, pneumatic dilation and laparoscopic Heller myotomy should therefore consider disease characteristics, operator expertise, prior therapy, local resources and the patient’s preferences. The study provides strong comparative evidence for integrating endoscopic therapy into modern upper-GI practice.
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This randomized clinical trial directly compared peroral endoscopic myotomy (POEM) with pneumatic dilation in treatment-naive patients with achalasia. POEM produced greater improvement in symptom severity and a substantially higher rate of treatment success at the primary follow-up point. The study helped establish POEM as a major endoscopic option for achalasia rather than simply an experimental alternative. Its significance for surgeons and interventional endoscopists is that the therapeutic landscape for esophageal motility disorders now includes procedures that can achieve a myotomy without the external incisions required for traditional surgery. At the same time, the trial highlights an important trade-off: gastroesophageal reflux and reflux-related esophageal acid exposure can occur after POEM, so patients need appropriate counseling and follow-up. The choice among POEM, pneumatic dilation and laparoscopic Heller myotomy should therefore consider disease characteristics, operator expertise, prior therapy, local resources and the patient’s preferences. The study provides strong comparative evidence for integrating endoscopic therapy into modern upper-GI practice.
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