Tu1180 OPEN PERORAL ENDOSCOPIC MYOTOMY FOR THE TREATMENT OF ACHALASIA: A MINIMALLY INVASIVE TECHNIQUE

Abstract

Peroral Endoscopic Myotomy(POEM) is safe and effective for most patients with achalasia but creation of the submucosal tunnel during the POEM procedure is still challenging for patients with failed Heller myotomy or sigmoid-shaped esophagus. Inspired by the success of POEM for the treatment of achalasia, we investigated a method of direct peroral endoscopic myotomy without a submucosal tunnel for the treatment of achalasia, which we call Open Peroral Endoscopic Myotomy (O-POEM). This study aimed to evaluate the feasibility and efficacy of O-POEM for patients with failed Heller myotomy or sigmoid-shaped esophagus. In this study, O-POEM was performed in 3 patients with sigmoid-type achalasia (S1 type in 1 patient and S2 type in 2 patients) and 2 achalasia patients with failed Heller myotomyat West China Hospital, a tertiary referral center in China between August 2016 and December 2016. A retrospective analysis was conducted, including the rate of symptom relief during follow-up, defined as an Eckardt score of ≤ 3, an Eckardt score, manometry, timed barium esophagram, procedure-related adverse events, reflux symptoms, and recurrence during follow-up. O-POEM was achieved successfully in all the patients. The mean operation time was 23.8 min (range 19-28 min). A reduction of Eckardt score and a timed barium esophagogram were observed during follow-up. There were no severe complications and no recurrences at 12 to 15 months of follow-up. O-POEM is a feasible and effective endoscopic treatment modality for achalasia with failed Heller myotomy or sigmoid-shaped esophagus. The O-POEM procedure for the treatment of achalasia is easier and less time-consuming. The short-term outcomes of O-POEM for achalasia were excellent, resulting in short-term symptom relief in all cases without serious complications.