World Congress of Gastroenterology

WCOG 2019


 
POEM in Prague since 2012: A Single Center Experience with more than 300 POEMs for Achalasia
ZUZANA RABEKOVA 1 ZUZANA VACKOVA 1 TOMAS HUCL 1 PETR STIRAND 1 JULIUS SPICAK 1 EVA KIESLICHOVA 1 RADIM JANOUSEK 1 JAN MARTINEK 1

1- INSTITUTE FOR CLINICAL AND EXPERIMENTAL MEDICINE
 
Background/Aims:

POEM has already proved excellent mid-term efficacy even when compared with other standard methods for achalasia, but the long-term durability still needs to be confirmed. Nevertheless, the high risk of postPOEM reflux tempers the enthusiasm. The aim of our case series was to assess the long-term clinical outcome and a thorough analysis of postPOEM reflux.

Materials and Methods:

A retrospective analysis of prospectively collected data of consecutive patients undergoing POEM at our tertiary center (12/2012-2/2019). All patients were scheduled for follow up at 3, 6, 12M after the procedure and every year thereafter. Upper GI endoscopy, HRM and 24-hour pH-metry were performed 3M after POEM; endoscopy was then repeated between 24-36M. Main outcomes were treatment success defined as ES < 3, recurrence rate and parameters of postPOEM reflux evaluated by 24h pH-metry, presence of reflux esophagitis, reflux symptoms and use of PPIs.

Results:

A total of 292 achalatic patients underwent 306 POEMs. Follow- up visits at 3, 12, 24, 36 and 48M were completed in 250, 179, 131, 69 and 28 patients. Treatment success at 3M was achieved in 98% (CI 96- 100), at 12M in 95% (92- 98), at 24M in 90% (85- 95), at 36M in 82% (73- 91) and at 48M in 79% (67- 91) of patients. A total of 25 patients experienced treatment failure (n=6) or recurrence (n=19). At 3M, reflux esophagitis was observed in 107/251 (42.6%, mostly LA A). Abnormal acid exposure was detected in 93/215 (44.3%) patients. At 24-36M, endoscopy was performed in 84 patients and reflux esophagitis was present in 27 patients (32.1%). PPIs were administered on average to 36.8% of patients at the follow up visits.   

Conclusion:

POEM successfully amended the spectrum of effective treatment modalities for achalasia with sustained treatment success of 90% at 24M and still favorable 79% at 48M after the procedure. PostPOEM reflux (usually mild, successfully manageable with PPIs) is present in almost 40% of patients, thus remaining a crucial clinical challenge in safety profile of POEM.

Keywords:

 peroral endoscopic myotomy, POEM, achalasia, postPOEM esophagitis