PS01.026: CHANGES IN SURGICAL PROCEDURES AND SHORT-TERM OUTCOMES FOR ACHALASIA SINCE THE INTRODUCTION OF POEM

Abstract

Abstract Background In our institution, laparoscopic Heller-Dor procedure (LHD) has been the first-line surgical procedure for achalasia since the introduction in August 1994, and 578 patients underwent LHD until January 2018. In January 2016, per-oral endoscopic myotomy (POEM) was started, taking into patients’ needs into consideration. Since then, treatment options have expanded to include balloon dilation, conventional LHD, LHD by reduced port surgery (RPS), LHD by needlescopic surgery (NS), and POEM. Here, we report changes we have observed in surgical procedures and short-term outcomes since the introduction of POEM. Methods The subjects were 82 patients (mean age 47.4 ± 14.7 years, 39 women) who underwent surgery for achalasia from January 2016 to January 2018. After explaining the advantages and disadvantages, the choice of surgical procedure was decided by the patient. Results The surgical procedures consisted of LHD in 57 (including 1 RPS and 33 NS) and POEM in 25 patients. A total of 7 peri-operative complications (POEM = 1) were observed in 7 patients (9%), consisting of gastroesophageal mucosal injury (7%, LHD) and injuring of esophageal longitudinal muscles (2%, POEM), while dysphagia improved in all patients. Postoperative reflux esophagitis was observed in 9 patients with POEM (36%), which was significantly higher than 6 patients (11%) in LHD (P = 0.0173). Conclusion While 30% of patients underwent POEM, reflux esophagitis occurred at a higher rate in POEM as compared to LHD. Disclosure All authors have declared no conflicts of interest.