Sa1234 A THOUSAND AND A HUNDRED FORTY PERORAL ENDOSCOPIC MYOTOMY FOR ESOPHAGEAL ACHALASIA: 10 YEARS’EXPERIENCE FROM A SINGLE TERTIARY CENTER

Abstract

Esophageal achalasia is most commonly treated with endoscopic dilation or laparoscopic Heller myotomy. Peroral endoscopic myotomy (POEM) has recently been described as a novel treatment for achalasia in humans. The aim of this study was to assess the clinical effectiveness and safety of POEM for treating esophageal achalasia performed in a single tertiary center within 10 years. Between June 2010 to May 2019, POEM was performed in 1140 consecutive patients with achalasia. POEM procedure consisted of the following step: firstly, submucosal tunnel was created and extended below the lower esophageal sphincter (LES) onto the gastric cardia after a mucosal incision was made; then endoscopic myotomy of circular muscle bundles was done; finally, the mucosal entry was closed by hemostatic clips. The Eckardt score and manometry were used to evaluate the outcomes. POEM was successfully performed in 1115 of 1140 cases (97.8%). Mean procedure time was 47.1 min (range 33-86) and mean myotomy length was 9.5 cm (range 7-16). Mucosal perforations occurred in 23 (2%) patients during submucosal tunnel creation, major bleeding occurred in 15 (1.3%) patients, and 29 (2.5%) patients suffered pneumothorax immediate after procedure. All the complications were managed conservatively. During a mean follow-up period of 49.3 months (range 5-89 months), treatment success was achieved in 1005/1140 patients (88.2%). Mean LES pressure was 57.5 mmHg (29.2-83.1) and 15.6 mmHg (5.2-23.1) before and after the procedure (P = 0.000), respectively. Mean Eckardt score was 6.1 (4-11, median 6) and 0.6 (0-3, median 1) before and after POEM, respectively (P = 0.000). In a multivariate analysis, no independent predictors of treatment success was found. 215 patient (18.9%) developed mild reflux symptoms and required intermittent medication with proton pump inhibitors during the follow-up. Our study demonstrated that POEM is a safe, and effective treatment for achalasia during a long-term follow-up. Further studies are warranted to compare the clinical outcomes of POEM with other treatment modalities.