Sa1312 CLINICAL OUTCOME OF PERORAL ENDOSCOPIC MYOTOMY IN ADVANCED ACHALASIA TREATMENT STRATIFIED BY MORPHOLOGICAL SUBTYPES

Abstract

Peroral endoscopic myotomy (POEM) has been first-line treatment of achalasia. However, the efficacy and safety of POEM on advanced achalasia remains to be clarified. Our purpose was to evaluate the feasibility and clinical outcome of POEM for advanced AC with various esophageal morphological changes. From June 2015 to March 2019, a total of 50 patients were enrolled with advance achalasia (megaesophagus type in 23 patients, sigmoid type in 19 patients and both type in 8 patients). Primary endpoint was symptomatic relief during follow-up, defined as an Eckardt score ≤3. Secondary endpoints were intra-procedural details such as operation time, length of myotomy, post-treatment adverse events, hospital stay, as well as delayed AE, named gastroesophageal reflux disease (GERD). All patients successfully received endoscopic myotomy, with a mean procedure time of 38.5±26.3 (range, 10.7-162.6) min. In 10 patients (20%) adverse events were encountered, including mild (n=8) and moderate (n=6) without conversion to surgery and ICU admission. During a mean follow-up of 23.8 months, despite 41 (89.1%) patients achieved treatment success with a decrease in mean Eckardt score from 7.2 to 1.7 (P=6.7×10-9), only 4 (57.1%) patients in subgroup 3 (dilation and sigmoid esophagus) obtained clinical success. Symptomatic reflux occurred in 13 patients (13/46, 28.3%), and all reflux symptoms were easily controlled by intermittent oral medication with PPIs. In advanced achalasia patients with various esophageal morphological changes, POEM was a technically feasible, safe and effective option. POEM appears to be less effective in patients with significant dilated and distorted esophagus, which should be paid more attention in future managements.