Sa1251 PREDICTOR OF CLINICAL FAILURE OF PER-ORAL ENDOSCOPIC MYOTOMY: A LARGE SINGLE-CENTER EXPERIENCE

Abstract

Per-oral endoscopic myotomy (POEM) is considered as an effective and safe minimally invasive endoscopic treatment for esophageal achalasia and achalasia related motility disorders, and more than 2000 cases have been performed at our institution. Although POEM is a highly efficacious treatment, there have been reports of clinical failure and the cause of these failure is unknown. This study aimed to identify the predictor of clinical failure of POEM. We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive patients who underwent POEM for esophageal achalasia or achalasia related motility disorders at a tertiary-referral center between 2008 and 2019. Clinical failure of POEM was defined as primary failure with Eckardt score not decreasing to 3 or under during one-year follow-up. Patients were divided into two groups according to whether they had clinically successful POEM or failed POEM. Baseline characteristics (Age, sex, BMI, duration of symptoms, esophageal diameter, manometric diagnosis), anti-thrombotic agents, prior treatments, myotomy orientation, myotomy length were retrieved. Univariate and multivariate logistic regression analyses were performed to assess the predictive factors of clinical failure (Table 1, 2). A total of 2091 POEM were performed, 1770 of whom had available 3-12 months follow-up data. Of those, 75 cases (4.2%) were considered failed POEM in short term follow-up. Multivariate analysis revealed that younger age (odd ratio [OR] 0.98, 95% confidence interval [95% CI] 0.97-0.99, P=0.009) , prior Heller myotomy ([OR] 4.13, [95%CI] 1.88-9.09, P<0.001), prior endoscopic balloon dilatation ([OR] 1.90, [95%CI] 1.15-3.15, P=0.012) were independent factors associated with clinical failure of POEM. Younger age, prior Heller myotomy, and prior endoscopic balloon dilatation were identified as the independent predictors of clinical failure of POEM in this single center large cohort study.View Large Image Figure ViewerDownload Hi-res image Download (PPT)