OGBN P03 Per oral endoscopic myotomy (POEM) for primary achalasia: single-centre, retrospective analysis of 128 patients

Abstract

Abstract Background Achalasia is a neurodegenerative motility disorder of the oesophagus, presenting with the main symptoms of dysphagia, weight loss, chest pain, and regurgitation. Surgical myotomy is considered the gold standard treatment. However, peroral endoscopic myotomy (POEM) seems to be a safe and effective alternative option which was introduced in 2008. POEM is a procedure performed endoscopically, which allows transection of the muscular fibres of the distal oesophagus and of the lower oesophageal sphincter. In our centre POEM has become a more frequent management option to treat primary achalasia when compared to surgical myotomy. The aim of the study is to analyse the outcomes from a single centre experience. Methods From June 2015 to May 2022, 128 patients underwent a POEM procedure to treat primary achalasia. We performed a retrospective analysis focusing on short term outcomes. Results All 128 patients underwent gastroscopy and manometry as part of the pre-operative workup to diagnose achalasia. Out of the 128 patients, 66 (52%) were women with age ranging from 17 to 79. BMI values ranged from 17 to 42. At 3/128 occasions the procedure was abandoned due to technical difficulty with all 3 patients at the early days of performing POEM highlighting the learning curve of the procedure. 6/128 patients had ongoing symptoms of achalasia post POEM and went on to have a laparoscopic Heller's myotomy. Median length of stay is 2 days (1–11). 6/128 had Clavien Dindo complications class 2 and 2/128 patients required aspiration of peumoperitoneum intra-op and one patient requiring chest drain insertion for surgical emphysema. 15/128 patients had a post-operative water soluble contrast swallow study to exclude leak following challenging cases or concerns for perforation. The median Eckardt score at last follow-up decreased from 7 to 1. Conclusions Our results show that POEM is a safe procedure to treat primary achalasia with minimal complications and preferable outcomes for patients in terms of symptom control. It can performed safely by experienced oesophageal surgeons and there are very good short-term outcomes. In our unit POEM is the primary treatment modality for achalasia.