A40 INITIAL OUTCOMES FOLLOWING THE LAUNCH OF A PERORAL ENDOSCOPIC MYOTOMY (POEM) PROGRAM FOR ACHALASIA: A SINGLE-CENTRE EXPERIENCE IN CANADA
Bibliographic record
Abstract
Abstract Background Peroral endoscopic myotomy (POEM) has gained prominence as a minimally invasive therapeutic option for achalasia. Despite its growing adoption worldwide, the establishment of POEM programs in Canada is relatively recent, and local data on clinical outcomes remain limited. Aims This study aims to assess the short-term outcomes of patients undergoing POEM for achalasia including symptom improvement, complication rates, and detailing the endoscopic and hospital resources necessary to sustain a POEM program. Methods A retrospective chart review was conducted to collect procedural and clinical outcome data for patients who underwent POEM and completed follow-up assessments from the inception of the program in October 2023 to September 2024 at the Foothills Medical Centre in Calgary, Alberta. The Eckardt symptom score was used to objectively evaluate symptoms pre-operatively and one-month post-POEM. Results A total of 20 patients, with a mean age of 59.2 (± 13.4) years, completed a one-month postoperative assessment after POEM. Each procedure was performed jointly by a gastroenterologist and a thoracic surgeon in the operating room. Most patients (16/20) were classified as ASA category II. The median Charlson Comorbidity Index was 2. 65.0% of patients had prior endoscopic interventions for achalasia, including pneumatic dilation or botulinum toxin injection. The pre-procedural mean integrated relaxation pressure at the lower esophageal sphincter was 25.8 ± 11.4 mmHg. The mean POEM procedural time was 110.5 (± 33.6) minutes, with an average of 6.5 endoscopic clips used per case for tunnel closure. The esophageal myotomy lengths were 4.79 (± 0.38) cm for type I and type II achalasia, and 9.0 (± 0.89) cm for type III achalasia. The postoperative length of stay was a median of 1 day. Postoperative complications occurred in 2 patients, both of which were managed conservatively, with no procedure-related deaths. The mean pre-POEM Eckardt score was 7.00 (± 1.79), which decreased to a mean of 1.00 (± 0.89) at one-month post-POEM (p < 0.001) [Figure 1]. Conclusions POEM is a safe and effective treatment option for patients with symptomatic achalasia. We demonstrate marked initial symptom improvement and a low complication rate. However, POEM is resource- and time-intensive. Further studies are warranted to evaluate long-term outcomes and complications such as gastroesophageal reflux disease (GERD) and Barrett’s esophagus. Figure 1: Total Eckardt symptom score before and after POEM. Each line represents data from an individual patient. Funding Agencies:
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".