BACKGROUND AND STUDY AIMS: With the success of peroral endoscopic myotomy (POEM) 
in treatment of achalasia, its successful application to other spastic 
esophageal motility disorders such as Jackhammer esophagus has been noted. The 
question of whether the lower esophageal sphincter (LES) should be included in 
the myotomy for Jackhammer esophagus is a topic of current debate. Here, we 
report our experience and results with four patients with Jackhammer esophagus 
treated with POEM. The clinical and manometric results are presented and their 
potential implications are discussed.
PATIENTS AND METHODS: Between January 2014 and July 2015, four patients 
underwent POEM for treatment of Jackhammer esophagus at our center. Manometry 
was performed prior to and after POEM. All patients met the Chicago 
classification criteria for Jackhammer esophagus and received a barium 
esophagram and endoscopic examination before having POEM.
RESULTS: All patients had uneventful procedures without any intraoperative or 
post-procedure complications. Patients in which the LES was included during POEM 
had resolution or significant improvement in symptoms. One patient in whom the 
LES was preserved had resolution of chest pain but developed significant 
dysphagia and regurgitation. Subsequently this individual received a repeat POEM 
which included the LES, resulting in symptom resolution.
CONCLUSIONS: POEM is a suitable treatment for patients with Jackhammer 
esophagus. Until there are larger-scale randomized studies, we speculate that 
based on our clinical experience and physiologic and manometric observations, 
obligatory inclusion of the LES is justified to reduce the risk of symptom 
development from iatrogenic ineffective esophageal motility or subsequent 
progression to achalasia.