Tu1184 AFTER PERORAL ENDOSCOPIC MYOTOMY (POEM), POST-TREATMENT ESOPHAGOGASTRIC JUNCTION DISTENSIBILITY BY ENDOLUMENAL FUNCTIONAL LUMEN IMAGING PROBE (ENDOFLIP) PREDICTS TREATMENT SUCCESS BETTER THAN MANOMETRY OR TIMED BARIUM EMPTYING

Abstract

Peroral endoscopic myotomy (POEM) has emerged as a useful method to treat achalasia. Prior studies suggest that post-treatment basal LES pressure (LESP) and emptying on timed barium esophagram (TBE) correlate with symptom improvement; newer studies suggest that esophagogastric junction (EJG) distensibility index (DI) by EndoFLIP also correlates with response to therapy. Our aim was to compare post-POEM EndoFLIP DI, LESP, and TBE in patients with successful versus failed symptom improvement. Retrospective review of a prospectively maintained database of patients undergoing POEM at a single center. Patients with prior myotomy and fundoplication were excluded. Data collected included (a) demographics, symptoms, Eckardt score, and manometric diagnosis at presentation, (b) findings at the 3-month follow-up including Eckardt score, distensibility index (DI) at 30-40-50 ml assessed by EndoFLIP, TBE at 5 minutes, and LESP measured by high-resolution manometry. Treatment success was defined as Eckardt score ≤3. We evaluated the relationship between objective outcomes (DI, TBE, LESP) and treatment success at 3 months, through linear regression. Data are presented as mean (SD) or n (%). 22 patients were included: 4 (18%) Achalasia type I, 9 (41%) Achalasia type II, 5 (23%) Achalasia type III, 4 (18%) EGJ outflow obstruction. Mean age was 57.4, 55% were male, mean BMI was 27.4, baseline mean Eckardt score was 7.14. At 3 month follow-up, mean Eckardt score had decreased from 7.14 to 1.23; 20 patients (91%) achieved treatment success. Linear regression was calculated to predict Eckardt success based on each individual objective outcome. A statistically significant association was found was between treatment success and EndoFLIP DI at 30 ml (R2 of 0.194, p <0.040). There was no significant association between treatment success and DI at 40 ml and 50 ml, mean LESP, or complete emptying by TBE (Table 1). POEM is effective for treating achalasia. A higher EGJ DI at 30 ml on EndoFLIP correlates with treatment success, and thus may be the best predictor for post-treatment success. Data collection is ongoing in order to confirm this finding in a larger cohort with longer follow-up.Tabled 1Table 1. Linear RegressionObjective OutcomeR2CorrelationP-valueDI at 30 ml on EndoFLIP0.194-0.2250.040DI at 40 ml on EndoFLIP0.153-0.2120.072DI at 50 ml on EndoFLIP0.082-0.1950.196LESP0.047-0.0250.330TBE0.042-0.0770.375 Open table in a new tab