PS01.096: CHOOSING THE TREATMENT OPTION OF END-STAGE CARDIAC ACHALASIA

Abstract

Abstract Background Until recently the esophagectomy was the only choice in treatment of patients with end-stage achalasia. Developing of minimally invasive techniques such as a laparoscopic Heller miotomy and peroral endoscopic myotomy (POEM) allowed to use them as a treatment options. Aim: to present an experience of treatment of patents with end-stage cardiac achalasia. Methods Since 07.2013 till the 12.2017 eleven patients with end-stage cardiac achalasia were operated on. Among them 2 (18%) were males and 9 (82%) were females. Mean age was 54 years (26–81). Results POEM was performed in 6 patients, laparoscopic Heller myotomy was performed in 2, and esophagectomies were performed in 3 patients with failed previously myotomy made in other clinics. Gastric tube was used to replace the esophagus in patients underwent esophagectomy. Mean operative time was 90 min for POEM, 172 minutes for laparoscopic Heller procedure and 422 minutes for laparoscopic esophagectomy. Blood loss was insignificant in all patients. There were no clinically significant complications during the postoperative course of all patients. Mean postoperative hospital stay was 2 days after POEM, 4 days after laparoscopic Heller procedure and 11 days after esophagectomy. To asses the dysphagia after POEM and Heller procedure Eckardt scale was used. In all cases it was rated as grade 0. Conclusion Minimally invasive techniques such as POEM and laparoscopic Heller procedure should be the first options in surgical treatment of patients with end-stage cardiac achalasia. In case of ineffectiveness of these options esophagectomy should be performed. Disclosure All authors have declared no conflicts of interest.