OC.07.1 100 PERORAL ENDOSCOPIC MYOTOMIES: PRELIMINARY OUTCOMES OF THE LARGEST PROSPECTIVE EUROPEAN SERIES

Abstract

Background and aim: Peroral Endoscopic Myotomy (POEM) is a new technique for the treatment of achalasia that combines the long term benefits of surgical myotomy with the advantages of a less invasive, intervention. Published European series includes only few patients, with a very short follow-up. Aim of this study is to report the outcomes of a large series of adults treated with POEM, in a single center. Material and methods: Between May 2011 and October 2013, 103 adults patients underwent POEM (42 men, mean age 48.9 years, [range 18–77]). 74 patients had a classic type achalasia, 29 a vigorous type. Preoperative mean basal LES pressure was 40 mmHg (11-97.4); mean Eckardt score was 8 (4-11). Clinical success was defined by an Eckardt score ≤3. Adverse events were recorded. Incidence of postoperative GERD was particularly considered. Results: POEM was successfully completed in 97 (94.2%) patients, in a mean of 83 minutes. Operating time was significantly longer during the first 25 cases compared to the following cases. In 6 patients POEM aborted because of the inability of creating the submucosal tunnel. Mean length of myotomy 12 cm (7-17 cm). No complications occurred. Mild advert events included transient pneumoperitoneum (30%) and asymptomatic esophageal ulcers (23.3%). Patients were fed on the 2nd post-operative day on average. Mean follow-up after POEM was 7 months: 7 patients completed the 24month and 29 the 12-month follow-up. Two patients were lost at follow-up. The procedure was clinically successful in 92 patients (97%). Mean Eckardt score significantly dropped from 8.1 at baseline, to 0.8, 1.1, 0.9, 1.4 and 1.4, respectively after 3, 6, 12, 18 and 24 months. Mean basal LES pressure significantly dropped from 41 mmHg at baseline to 18 mmHg at the 12-month follow-up. Functional tests documented GERD in 18/57 (31.6%) of patients. Erosive esophagitis was seen in 19% of patients at 6-month follow-up, but only 17% of patients referred heartburn. Conclusions: POEM is feasible and effective for the treatment of esophageal achalasia. Despite an high incidence of iatrogenic GERD, the majority of patients had no symptoms, and did not receive any treatment. Additional studies with a long follow-up, and comparative trials versus pneumodilation or surgical myotomy are necessary to confirm its role in the treatment of esophageal achalasia.