733 International Multicenter Experience With PerOral Endoscopic Myotomy (POEM) for the Treatment of Spastic Esophageal Disorders Refractory to Medical Therapy

Abstract

according to the ASGE lexicon’s severity grading system. The length of procedure (LOP) and LOP per centimeter myotomy were trended in consecutive POEM procedures and used as a marker to determine the learning curve. Results: A total of 26 patients (mean age 46, 15 Female) underwent POEM for treatment of achalasia (type I 1, type II 19, type III 2) or SED (Jackhammer Esophagus 4). POEM was successfully performed in the endoscopy suite and completed in all patients (anterior approach 24, posterior approach 2) with a mean LOP of 135 minutes (range 69-216 min). The mean length of submucosal tunnel was 13 cm (range 9-24). The mean myotomy length was 10 (range 7-19cm) (esophageal 7 cm, cardia 3 cm). There was significant decrease in Eckhardt score after POEM (8.27 vs. 0.95, pZ!0.0001). Overall, clinical response was observed in 25 (96%) patients. Abnormal acid exposure (symptomatic and asymptomatic) occurred in 7 (27%) patients. The mean LES pressure decreased significantly after POEM (28 vs. 18, pZ0.05). A total of 3 complications occurred in 3 patients with 1 complication rated as mild, 2 moderate and none severe. Mucosotomy occurred in 2 (7%) patients and were successfully treated with endoscopic closure. The mean length of hospital stay was 2.6 days (range 1-10). The mean LOP significantly decreased after 13 procedures (142 min vs. 114 min pZ0.04). Similarly, the mean LOP per cm myotomy significantly decreased after 13 procedures (15.5min/cm vs. 11 min/cm pZ0.009). Conclusions: POEM can be effectively and safely performed by experienced gastroenterologists in a tertiary care endoscopy unit. The learning curve for POEM plateaus at around 13 cases for experienced endoscopists. 733 International Multicenter Experience With PerOral Endoscopic Myotomy (POEM) for the Treatment of Spastic Esophageal Disorders Refractory to Medical Therapy Mouen Khashab*, Ahmed a. Messallam, Manabu Onimaru, Ezra N. Teitelbaum, Michael B. Ujiki, Matthew E. Gitelis, Rani J. Modayil, Eric S. Hungness, Stavros N. Stavropoulos, Mohamad H. El Zein, Hironari Shiwaku, Rastislav Kunda, Alessandro Repici, Hitomi Minami, Philip W. Chiu, Jeffrey Ponsky, Amit P. Maydeo, Haruhiro Inoue Johns Hopkins Medical Institute, Baltimore, MD; Nagazaki University Hospital, Nagazaki, Japan; Winthrop University Hospital, Rock Hill, SC; Showa University Northern Yokohama Hospital, Yokohama, Japan; Fukuoka University Faculty of Medicine, Fukuoka, Japan; Aarhus University Hospital, Aarhus, Denmark; University Hospitals Case Medical Center, Cleveland, OH; Institute of Digestive Disease The Chinese University of Hong Kong, Shatin, Hong Kong; NorthShore University HealthSystem, Evanston, IL; Humanitas research hospital, Milano, Italy; Northwestern Univeristy, Chicago, IL; Baladota institute of digestive sciences, Mumbai, India Background: POEM is potentially an ideal endoscopic therapy for refractory spastic esophageal disorders (SED) since it not only allows myotomy of the lower esophageal sphincter (LES) but also of the esophageal body, where the hypertensive contractions occur. Limited data exist on the use of POEM for therapy of these difficult-to-treat disorders. Aims: To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm (DES), Jackhammer esophagus (JE), or type III (spastic) achalasia. Methods: All patients who underwent POEM for treatment of SED refractory to medical therapy at 11 centers (5 US, 2 European, 4 Asian) were included. Diagnosis was based on manometric findings. Relevant clinical, manometric, and endoscopic data were abstracted and preand post-procedural symptoms (e.g. Eckardt scores) and manometry were recorded. Clinical response was defined by improvement of symptoms and decrease in Eckardt score to %3. Adverse events were graded according to the ASGE lexicon’s severity grading system. Results: A total of 68 patients (mean age 58 years, 45.5% Female) underwent POEM for treatment of SED [DES 8 (11.7%), JE 10 (14.7%), type III achalasia 50 Table 1. Studies using Plastic Stents for Endoscopic Drainage Study No. of Patients Clinical success (%) All Adverse Events Varadarajulu 2013 20 95 0