Sa1313 ANALYSIS OF SAFETY AND EFFICACY OF PERORAL ENDOSCOPIC MYOTOMY FOR ACHALASIA: A SINGLE-CENTER EXPERIENCE WITH MID-TERM FOLLOW-UP

Abstract

Peroral endoscopic myotomy (POEM) has been introduced as a new effective therapeutic option for achalasia. This abstract illustrates our experience with POEM in a large single-center series of achalasia patients with mid-term follow-up. A retrospective review was conducted that included all consecutive patients with achalasia who underwent POEM between January 2016 to December 2018 in a tertiary care center. The primary outcome was clinical response, defined as an Eckardt score lower than 3. Secondary outcomes were procedure-related adverse events (graded according to the ASGE lexicon's severity grading system) and incidence of postoperative gastroesophageal reflux disease. A total of 206 patients (mean age 40.6 years, 94 males) underwent POEM for the treatment of achalasia (35 type I, 137 type II, 34 unspecified). Of these, 40 (19.4%) had received previous treatment for achalasia before POEM, including 27 pneumatic dilation, 8 prior POEM, 3 Heller myotomy, 1 botulinum toxin injection and 1 temporary esophageal stenting. Technical success was achieved in all patients. Posterior myotomy was performed in 70.9% of patients. Adverse events occurred in 20 (9.7%) patients. There were 9 inadverted mucosotomies, 5 pneumonia, 3 cardiac arrhythmia, 2 symptomatic pneumothorax requiring needle decompression, 1 pleural effusion requiring chest tube insertion. Fifteen adverse events were grade as mild, 5 moderate, and none severe. Among 185 patients with median follow-up period of 24 months (IQR 12.0-29.3), clinical success was achieved in 87.0% of patients, and Eckardt scores improved from pre-operative 6.4±1.9 to post-operative 1.4±1.6 (P <0.001). There were no significant differences in the success rate among the achalasia subtypes (P =0.947). Postoperative upper endoscopy revealed esophagitis in 19.5% of patients (5 LA grade A, 12 LA grade B), while 11.9% of patients had post-operative symptoms suggestive of gastroesophageal reflux (GerdQ >7). The present large series add to the evidence that POEM is a safe and effective treatment for achalasia patients, resulting in mid-term symptom relieved in nearly 90% of patients without severe adverse events.