POEM PROCEDURE PERFORMED IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS NOT INCLUDED IN THE CHICAGO CLASSIFICATION – EXPANDING POEM INDICATIONS

Aims To present our experience in POEM for patients with esophageal motility disorders (EMD) not included in the Chicago Classifacation (CC).

Methods Case series from a national prospective database June 2016 to November 2019.

Results Patients 1 & 2: 48 y male and 52 y female. Dysphagia and chest pain. Previous interventions: patient 2 had Botox injection and endoscopic dilatation before POEM. Manometry: normal peristaltic segment in upper esophageal body (S2) but rapidly propagated vs compartmentalized pressure in distal esophageal body (S3). Normal distal latency (DL) and normal lower esophageal sphincter (LES) relaxation. POEM: 11 and 13 cm esophageal body + 2 cm gastric manometry-guided myotomy. Both asymptomatic 28 and 7 months after POEM. No esophagitis was found. One of the patients had abnormal pH testing (7.2%).

Patient 3: 68 y male. Dysphagia and chest pain. Endoscopy: “spiral staircase” esophagus. Manometry: post swallow persistently contracted segment with normal distal latency not fulfilling Jackhammer Esophagus (JE) criteria with normal LES relaxation. POEM: 12 cm esophageal body + 2 cm gastric myotomy performed. Asymptomatic 25 months post procedure.

Patient 4: 56 y male. Dysphagia and chest pain. Previous interventions: LHM performed in 2011. Manometry: premature contractile segment in upper esophageal body with aboral compartmentalized pressure preceding a surgically abolished distal segment. Normal LES relaxation. POEM: 10 cm esophageal body exclusive myotomy. Asymptomatic 14 months after procedure.

Patient 5: 78 y female. Dysphagia. Previous interventions: three dilatations performed. Manometry: 11 cms simultaneously contractile mid and distal esophageal segment. Abnormal LES relaxation. POEM: 15 cms esophageal body + 2 cm gastric myotomy. Asymptomatic 1 month after procedure

Conclusions POEM guided through manometry is a state-of-the-art technique with promising results that allows treatment of EMD undefined by the CC. Thus, guidance of HRM con expand POEM indications. This short series is a pilot study preceding a multicenter evaluation.