Endoscopy 2019; 51(04): S82
DOI: 10.1055/s-0039-1681411
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: Motility 1 Forum
Georg Thieme Verlag KG Stuttgart · New York

PERORAL ENDOSCOPIC MYOTOMY FOR ESOPHAGEAL ACHALASIA: OUTCOMES OF THE FIRST 500 PATIENTS WITH A MID- AND LONG-TERM FOLLOW-UP

F Mangiola
1   Fondazione Policlinico Universitario A. Gemelli IRCSS, Digestive Endoscopy Unit, Rome, Italy
,
P Familiari
1   Fondazione Policlinico Universitario A. Gemelli IRCSS, Digestive Endoscopy Unit, Rome, Italy
,
R Landi
1   Fondazione Policlinico Universitario A. Gemelli IRCSS, Digestive Endoscopy Unit, Rome, Italy
,
V Bove
1   Fondazione Policlinico Universitario A. Gemelli IRCSS, Digestive Endoscopy Unit, Rome, Italy
,
I Boskoski
1   Fondazione Policlinico Universitario A. Gemelli IRCSS, Digestive Endoscopy Unit, Rome, Italy
,
A Tringali
1   Fondazione Policlinico Universitario A. Gemelli IRCSS, Digestive Endoscopy Unit, Rome, Italy
,
A Costantini
1   Fondazione Policlinico Universitario A. Gemelli IRCSS, Digestive Endoscopy Unit, Rome, Italy
,
V Perri
1   Fondazione Policlinico Universitario A. Gemelli IRCSS, Digestive Endoscopy Unit, Rome, Italy
,
G Costamagna
1   Fondazione Policlinico Universitario A. Gemelli IRCSS, Digestive Endoscopy Unit, Rome, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Peroral endoscopic myotomy (POEM), which combines the efficacy of surgical myotomy with the benefits of an endoscopic, minimally invasive, procedure, is considered now an effective treatment for achalasia. We report on the mid- and long-term outcomes of a large series of patients treated in a single European center.

Methods:

The first 500 adult patients successfully treated between May 2011 and January 2018 were retrospectively identified from a prospective database, and included in this study. Demographics, clinical, procedural and follow-up data were collected and analysed.

Results:

Mean age of patients was 51 years (18 – 85); the 50.1% were male. Treatment naïve patients were 79.4%; 14.4% had undergone pneumatic dilatation, 2.6% botulin toxin injection, 3.6% Heller-Dor. The 16.6% of patients had a type-I achalasia, 57.2% type-II, 13.8% type-III, 1.2% Jackhammer esophagus, 0.8% distal esophageal spam; in 10.4% of patients achalasia type was not adequately classified. Mean symptoms duration before POEM was 24 ± 64.1 months. Mean operative time was 62.6' (19 – 180 minutes). Mild complications occurred in 5 patients (1%) and were managed conservatively.

A mean 23.7 months (3 – 60 months) follow-up was available for 96.7% of patients. Clinical success was documented in 98% of patients, and was 96%, 96%, and 86.4% after 6, 24 and 60 months respectively. Thirteen patients with failure underwent pneumodilation with success, 4 have persisting symptoms after pneumodilation, 3 underwent surgery.

Success was 97.5% in achalasia-patients and 81.8% in those with spastic motility disorders (p < 0.05).

An altered esophageal pH-study was diagnosed in 31.2% of patients; esophagitis-rate was 27.7% (86.9% grade A/B; 13.1% grade C/D).

At the date of the last follow-up, 34.6% of patients receive daily PPI for GERD.

Conclusions:

Our results confirm the efficacy of POEM in a large cohort of patients, with an adequate follow-up. Benefits of POEM seem durable, with and acceptable incidence and severity of iatrogenic GERD.