A52 PERORAL ENDOSCOPIC MYOTOMY (POEM) FOR TREATING ACHALASIA: A SINGLE CENTER’S RESULTS

Achalasia, a primary esophageal motor disorder characterized by insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis, results in dysphagia, chest pain, regurgitation and weight loss. Peroral endoscopic myotomy (POEM) is a recently developed method of treating achalasia, less invasively than surgical myotomy. The objective of this study was to report the early outcomes of a series of patients treated with POEM in a single Canadian center. 11 consecutive patients with achalasia (8 men, 3 women, mean age 51.82 years [range 31–80], mean duration of symptoms 100 mo [range 10 mo–30 yrs]) from a single tertiary center in Kingston, Ontario underwent 12 peroral endoscopic myotomies (POEM) between March 2016 and Sept 2016. A submucosal tunnel extending to the gastroesophageal junction was created endoscopically and then an endoscopic myotomy (mean length 12.92 ± 2.84cm in the distal esophagous, 3.17 ± 0.43cm in the cardia) of the circular muscle bundles was performed. The mucosal defect was closed with hemostatic clips (5 ± 0.43). The mean operating time was 117.17 ± 30.8 min. Pre- and post-operative assessments included Eckhardt scores, barium swallow, endoscopy and manometry. There were no complications. The mean Eckardt score pre-procedure was 7.90 ± 1.1 (range 6–10). 9 patients underwent follow-up [mean duration 2.33 ± 1.5 mo, range 0–5 mo] with post-procedure Eckardt score of 0.78 ± 0.97 (range 0–3). The improvement was statistically significant (p<0.05). There was no significant difference in the improvement of symptoms in patients with type 2 achalasia (n=2) [pre-procedure Eckardt 8.67, post-procedure Eckardt 0.00, difference 8.67] and patients with type 3 achalasia (n=5) [pre-procedure Eckardt 8.17, post-procedure Eckardt 1.00, difference 7.17]. Patients with >1 previous treatments (n=3) for achalasia, including balloon dilation, botox injection and Heller myotomy, experienced statistically significant improvement in their symptoms [mean pre-procedure Eckardt 8.00 ± 0, mean post-procedure Eckardt 1.33 ± 1.55, p<0.05]. Of four patients who underwent follow-up endoscopy, none had any endoscopic evidence of esophagitis. A difficulty score involving tunnel distension, abnormal contractions, submucosal oozing, submucosal fibrosis, tunnel orientation was calculated (mean score 2.67). The mean difficulty score per morphology was as follows: non-sigmoid non-dilated, 2.17; non-sigmoid dilated, 2.50; sigmoid S1, 2.50; sigmoid S2, 4.00. Difficulty score was found to strongly correlate with operative time (r=0.88). POEM is a safe and effective method of managing achalasia, specifically in groups that have been previously shown to be less responsive to surgical therapy, e.g. type 3 achalasia and those with previous anti-achalasia procedures. A difficulty score has been shown to correlate with operative time and warrants further investigation. None

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