LONG – TERM RESULTS OF PERORAL ENDOSCOPIC MYOTOMY (POEM) FOR ACHALASIA

Abstract Background POEM has gained trust by proved safety and short-term efficacy and at present, it is considered as a standard and safe method for treatment of achalasia. The aim of this prospective single-center case series was to assess the long-term efficacy of POEM with emphasis on post-POEM reflux and to summarize adverse events. Methods Since 2012 until 10/2017, a total of 223 achalatic patients underwent 233 POEMs. Follow-up visits at 3, 12, 24 and 36M were completed in 194, 144, 80 and 44 patients. 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 (Eckardt score <3), recurrence rate, post-POEM reflux and adverse events. Results At 3, 12, 24 and 36 months, treatment success was achieved in 97% (CI 95%; 95–100), 99% (97–100), 94% (88–100) and 93% (86–100) of patients. A total of 15 patients experienced treatment failure (n = 5) or recurrence (n = 10). The recurrences occurred most often in patients with achalasia type I (4 out of 35, 11.4%) followed by type II (5 out of 144; 3.5%) vs. none in type III (0 out of 21.0%); P = 0.022. At 3 months, reflux esophagitis was diagnosed in 68/194 patients. Abnormal acid exposure was detected in 68/194 (39.7%) patients. At 24–36 months reflux esophagitis was present in 15 from 51 patients (29%). The most common adverse event was capnoperitoneum with necessity of a puncture (57.6%), subcutaneous emphysema (36.6%). A total of 3 severe adverse events occured: 2 patients required a prolonged hospitalization due to fluido- and pneumofluidothorax. One patient (67 years) experienced electromechanical dissociation with fatal cardiac arrest during the procedure, the resuscitation was not successful. The autopsy revealed severe coronary disease and pulmonary hypertension (unrecognized prior to POEM), these conditions were considered likely to be the cause of the death. Conclusion POEM is effective treatment modality for achalasia with treatment success of 94% at 2 and 3 years. Reflux esophagitis and abnormal acid exposure are diagnosed in almost 40% of patients; reflux is successfully manageable with PPI. Eventhough POEM is considered a safe procedure, severe (fatal) adverse events may occur. Disclosure All authors have declared no conflicts of interest.