379 Safety and Efficacy of Peroral Endoscopic Myotomy (POEM) in Patients ≥ 65 Years at a Single Academic Tertiary Care Center

Abstract

INTRODUCTION: Peroral endoscopic myotomy (POEM) has been proven to be effective for treating esophageal dysmotility disorders. Herein is a report of the safety and efficacy of POEM in patients aged ≥65 years at an academic US tertiary care center. METHODS: Medical charts of all patients aged ≥65 years that underwent POEM between December 2014 and October 2018 were retrospectively reviewed. Demographic data, clinical data and treatment outcomes were obtained. POEMs were performed by multidisciplinary teams each including 1 of 2 endoscopists (HG, RE) and 1 of 3 surgeons (KP, PN, JK). Clinical success was defined as Eckardt score ≤ 3 and improvement of symptoms. RESULTS: During the study period, 62 patients were included. The mean age of patients was 72.3 ± 5.7 years (range 65-89 years; 42% women). Mean BMI was 29.8 kg/m2. Indications for POEM included Achalasia 88.7%, diffuse esophageal spasm (DES) 6.5%, Jackhammer esophagus 3.2% and esophagogastric junction outflow obstruction (EGJOO) 1.6%. There were 2 intraoperative complications documented (pneumothorax and anaphylaxis to medication). Mean pretreatment IRP was 24.1. Pretreatment Eckardt score was 6.98 ± 2.2 compared with posttreatment Eckardt score of 1.25 ± 2 (P < 0.05). Clinical success (Eckardt score ≤3) was achieved in 88.7% of patients. Mean myotomy length 13.8 cm (posterior orientation of myotomy 75.8%). Median hospitalization duration was 1.9 days. Postoperative complications included 1 patient with esophageal leak on postoperative esophagram, 1 patient with esophageal stricture, and 1 patient with both stricture and leak. No deaths occurred. Six patients with persistent symptoms post POEM required through-the-scope dilation to achieve improvement in symptoms. CONCLUSION: POEM can be safely carried out in symptomatic elderly patients ≥ with esophageal dysmotility disorders. An excellent clinical response (88.7%) was noted in this patient cohort.