437 Peroral Endoscopic Myotomy Is a Safe and Effective Treatment Modality for Geriatric Patients With Achalasia

Abstract

INTRODUCTION: Peroral endoscopic myotomy (POEM) is an emerging treatment modality for achalasia. It is a particularly appealing treatment option in older patients, as it is minimally invasive like an endoscopic procedure and highly effective as surgical myotomy. However, there is lack of a systematic study analyzing and comparing POEM outcomes in young (< 65 years) and geriatric patients (≥65 years). Hence, our study aims were to assess and compare the safety and efficacy of POEM in young versus geriatric patients. METHODS: Medical records of all achalasia patients who underwent POEM at our institution between April 2014 and May 2019 were reviewed. Patients who underwent timed barium esophagram (TBE) and high-resolution manometry (HREM) prior to POEM along with two-month post-POEM esophageal pH study, TBE and HREM were included. Patients were categorized into two groups as: young (<65 years) and old (≥65 years). Demographic and procedural details, TBE, HREM, pH study findings and Eckardt scores were compared between the two groups. Post-POEM Eckhardt score of ≤3 was considered as successful palliation of symptoms. RESULTS: 148 patients met the study criteria (<65 years = 93; ≥65 years = 55). Younger patients were more likely to have higher BMI, but fewer comorbidities and lower TBE height at 1 minute but wider TBE width at 5 minutes. Rest of the TBE parameters, pre-operative Eckardt's score and lower esophageal sphincter-integrated relaxation pressure (LES-IRP) were similar between the two groups. Young patients were more likely to have undergone prior Heller myotomy, where as Botox injections were more common in older group. The operative time, total myotomy length, complications, length of stay and 30-day readmission rates were similar in the two groups (Table 1). POEM was successful in 94.5% young and 96% old patients. At two-month follow up, both groups showed significant improvements in Eckhardt scores (Figure 1a) and HREM parameters, however older patients showed greater improvement in TBE height at 1 and 5 minutes (Figure 1b,c). The rates of symptomatic GERD and abnormal esophageal pH study findings were not significantly different between the two groups (Table 2). CONCLUSION: POEM is a safe and effective treatment option for geriatric patients with achalasia similar to younger patients. POEM might emerge as the preferred approach for myotomy in this patient population, because of its low morbidity compared to surgical myotomy.