A207 SLING-FIBER PRESERVATION DURING POEM IS AN INDEPENDENT FACTOR IN REDUCING POST-POEM GERD SYMPTOMS: A CANADIAN SINGLE-CENTER RETROSPECTIVE STUDY
Bibliographic record
Abstract
Abstract Background Gastroesophageal reflux disease (GERD) after peroral endoscopic myotomy (POEM) has been a limiting factor with POEM procedure. Preservation of the sling-fiber during POEM was reported to reduce post-POEM GERD in Japan, but there are no reports of this technique in a western population. Aims The aim is to investigate the association of sling-fiber preservation during POEM and post-POEM GERD symptoms at our institution, which is a large therapeutic endoscopy referral center in Canada. Methods This is a retrospective, single-center study of patients who underwent POEM from October 2017 to January 2023 at our center. The initial cohort of patients were treated by conventional POEM until June 2021, after which a second cohort underwent POEM with sling-fiber preservation, as the techniques advanced. The primary outcome was the rate of positive GERD symptoms after POEM. The secondary outcomes were clinical success rate, adverse events rate, use of PPI at follow-up. Multivariate regression was performed to identify factors that reduce post-POEM GERD symptoms. Results 148 POEM cases (52.5±15.6y/o, female:61(43%)) were included in this study. There was no significant difference in patient characteristics between the groups. The mean procedure time (108.6±34.5 vs 109.1±45.7 min, P=0.93) and rate of adverse events (20% vs 18%, P=0.85) were similar between the traditional and modified groups. In the sling fiber preservation group, gastric myotomy length was significantly longer (2.2±0.7 vs 1.6±0.8 cm, Pampersand:003C0.05) yet the GERD symptom rate at follow-up was significantly lower (22% vs 42%, Pampersand:003C0.05), although PPI use was similar (52% vs 48%, P=0.73). The clinical success rate was similar between groups (88% vs 84%, P=0.6). Regression analysis indicated that, after adjusting for other risk factors of post-POEM GERD, sling-fiber preservation during POEM had an odds ratio of 0.24 (95%CI:0.07-0.85, Pampersand:003C0.05) for post-POEM GERD symptoms. Conclusions Sling-fiber preservation during POEM effectively reduces post-POEM GERD symptoms, despite a longer gastric myotomy length. It stands as a independent factor in reducing post-POEM GERD symptoms. Hence, sling-fiber preservation may be a beneficial solution for reducing post-POEM GERD symptoms in Western populations. Outcomes of conventional POEM and sling-fiber preservation POEM POEM; Peroral endoscopic myotomy, SD; standard deviation, GERD; gastroesophageal reflux disease, PPI; proton pump inhibitor Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".