Comparison of the safety and efficacy of peroral endoscopic myotomy between octogenarians and non-octogenarians.

Abstract

This study compared the safety and efficacy of peroral endoscopic myotomy for esophageal motility disorders between octogenarians and non-octogenarians. This retrospective observational study recruited 321 patients (28 octogenarians and 293 non-octogenarians) who underwent peroral endoscopic myotomy from two institutions. Clinical success (postoperative Eckardt score≤3), technical success (completion of gastric and esophageal myotomy), and perioperative adverse events were compared between octogenarians and non-octogenarians. Perioperative adverse events were classified into major and minor adverse events based on the International Peroral Endoscopic Myotomy Survey criteria and were subdivided into technical and non-technical adverse events according to the presence of a direct causal relationship with the procedure. There were no significant differences in the rates of clinical success 1year after treatment (100% vs. 97.3%, P=0.64) and technical success (100% vs. 99.7%, P=0.91) between octogenarians and non-octogenarians. Octogenarians had a higher incidence of perioperative adverse events (28.6% vs. 10.2%, P=0.00097), particularly major adverse events (25.0% vs. 3.0%, P<0.0001). There were no significant differences in the incidence of minor adverse events (7.1% vs. 7.9%, P=0.67). Although there was no difference in the incidence of technical adverse events (10.7% vs. 9.2%, P=0.74), octogenarians had a significantly higher incidence of non-technical adverse events (17.9% vs. 1.0%, P=0.0002). There were no significant differences in short-term clinical success and technical success between octogenarians and non-octogenarians. However, octogenarians showed a significantly higher incidence of perioperative adverse events, particularly in major adverse events and non-technical adverse events. Peroral endoscopic myotomy for octogenarians should be carefully applied.