https://orcid.org/0000-0002-5893-6552
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Yusuke Fujiyoshi, Mary Raina Angeli Fujiyoshi, Christopher W Teshima, Evaluating the impact of sling fiber preservation during POEM, Diseases of the Esophagus, Volume 38, Issue 2, April 2025, doaf023, https://doi.org/10.1093/dote/doaf023
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We appreciate the interest of Nabi et al.1 in our paper to evaluate the efficacy of sling fiber preservation during Peroral endoscopic myotomy (POEM).2 We acknowledge their concern that a major limitation of our study is the reliance on patient-reported symptoms to evaluate outcomes. However, patient-reported outcomes remain crucial in achalasia management, as POEM aims to alleviate symptoms rather than cure the disease.
In our study, the sling fiber preservation group had a longer gastric myotomy length, which has been shown to improve the distensibility of the GE junction.3 Preservation of the sling fibers, along with a longer gastric myotomy, likely contributes to better GE junction opening while maintaining the angle of His. This may explain why the sling fiber preservation group demonstrated better Eckardt scores and lower GERD-Q scores compared to the conventional POEM group.
Furthermore, a recent meta-analysis also showed that sling fiber preservation reduces the incidence of post-POEM GERD symptoms.4 These findings reinforce our conclusions.
