S444 Short-Term Outcomes After Pneumatic Dilation in Non-Achalasia Obstructive Disorders of the Esophagogastric Junction

Abstract

Introduction: Treatment options for non-achalasia obstructive disorders of esophagogastric junction (EGJ) are limited. The aim of this study was to assess the treatment efficacy of pneumatic dilation (PD) for the disorders of the esophagogastric junction outflow obstruction (EGJOO) and post fundoplication esophagogastric junction obstruction (PF-EGJO) and to assess attitudes regarding training in PD. Methods: This was a two-part study. The main study was a prospective single-center study comparing treatment outcome after PD in patients with EGJOO and PF-EGJO, defined using manometry criteria, vs achalasia. Treatment success was defined as a post-PD Eckardt score (ES) of ≤ 2 at the longest duration of follow-up available. In a survey sub-study, a 2-question survey was sent to advanced endoscopy fellowship sites in the US (n=78) regarding training in PD. (Figure) Results: Of the 58% of respondents to the advanced endoscopy program director survey, 2/3 reported no training in PD at their program. The primary rationale cited was lack of a clinical need for PD. Sixty-one patients (15 Achalasia, 32 EGJOO, and 14 PF-EGJO) were included in the main study with outcomes available at a mean follow-up of 8.8 months. Overall, mean ES decreased from 6.30 to 2.89 (p < 0.0001); and mean % improvement in symptoms reported by patients was 55.3%. ES of ≤ 2 was achieved by 33/61 patients (54.1%). (Table) Conclusion: PD is an effective treatment for the non-achalasia obstructive disorders of the EGJ. It has limited complications and the potential ability to resolve suffering from untreated obstruction. Despite this, there is a current gap in training and technical expertise in PD.Figure 1.: Outcome of pneumatic dilation protocol is shown for each esophageal diagnosis. Panel A shows the magnitude of improvement in Eckardt score. Panel B shows the patient-reported % symptom improvement. Means with SEM are shown. Abbreviations - EGJOO: esophagogastric junction outflow obstruction, PF EGJO: post-fundoplication esophagogastric junction obstruction. Table 1. - Baseline Clinical Data by Subgroup (61 patients). Means with SEM are shown Achalasia (N = 15) EGJOO (N = 32) PF-EJGO (N = 14) p value Age (Years) 64.4 ± 3.9 61 ± 2.2 62.8 ± 1.9 p = 0.659 % Male 60 34.4 28.6 p = 0.158 BMI (kg/m2) 23.4 ± 1.2 29.4 ± 1.3 28.7 ± 1.8 p = 0.015 Supine IRP (mmHg) 28.1 ± 3.3 21.5 ± 1.0 23.1 ± 1.7 p = 0.043 BLESP (mmHg) 42.4 ± 4.2 44.1 ± 2.3 33.8 ± 1.6 p = 0.046 Distensibility Index (mm2/mmHg) 1.6 ± 0.3 1.1 ± 0.11 2.2 ± 0.28 p = 0.0012 Barium Tablet retention (%) 66.7 28.1 42.9 p = 0.043 Eckardt Score 7.3 ± 0.7 5.9 ± 0.5 6 ± 2.4 p = 0.255 BEDQ Score 31.7 ± 3.9 29.1 ± 2.4 26.9 ± 4.4 p = 0.667 Abbreviations: BEDQ – Brief esophageal dysphagia questionnaire, BLESP – basal lower esophageal sphincter pressure, BMI – body mass index, IRP – integrated relaxation pressure.