Sa1239 PER ORAL ENDOSCOPIC MYOTOMY (POEM): 10-YEAR OUTCOME FROM A LARGE US REFERRAL CENTER

Per oral endoscopic myotomy (POEM) is the prototype and most successful form of transluminal endoscopic surgery and is becoming the treatment of choice for achalasia. In 10/2009 we performed the first POEM out of Japan. We herein report our 10-year POEM experience, focusing on long-term efficacy data. This is a single-center prospective cohort study. A total of 610 patients received POEM at our institution between 10/2009-10/2019. There were 272 (44.6%) females and the median age was 55-year-old. Thirty-nine (11.3%) patients were≥ 80-year-old and 195 (32.0%) were ASA class III or IV. The Chicago Classification diagnosis was type I in 160 (26.2%), type II in 307 (50.3%) and type III achalasia in 93 (15.6%) patients, and EGJ outflow obstruction, DES or jackhammer esophagus in 23 (3.8%). The disease was stage I in 118 (19.4%), II in 341 (55.9%), III in 36 (5.9%) and IV in 115 (18.9%) patients. A total of 292 (47.9%) patients received one or more prior treatments, including 137 (22.5%) botulinum toxin injection, 108 (17.7%) dilation, and 83 (13.6%) Heller myotomy. There was no aborted POEM. The median operation time was 54 minutes. Accidental mucosotomy occurred in 75 (12.3%) patients and clinical-significant adverse event (csAE) occurred in 21 (3.4%) patients, including 2 (0.3%) with perioperative tunnel os dehiscence without leak, 8 (1.3%) delayed bleeding and 11 (1.8%) others. There was no csAE leading to death, surgery or drains. After a mean follow up of 35months (range 2-116), 29 failures occurred, defined as postoperative Eckardt score>3 or need for additional treatment. Kaplan-Meier POEM success estimates: 98%, 96%, 96%, 94%, 92% and 91% at 1, 2, 3, 4, 5, 6 yrs with only 2.3% of patients overdue/missing f/up. No risk factors for failure identified in Cox regression model. However, the non-achalasia patients were noted to have higher Eckardt score after POEM (mean 1.2 vs. 0.5, p<0.01), despite there being no difference before POEM (mean 7.6 vs. 7.9, p=0.56). After POEM, 125 (20.5%) patients had grade 2-3 reflux symptoms (≥twice/week). A total of 390 (63.9%) patients completed 48-hour Bravo study after POEM, of which 220 (56.4%) were positive. A total of 419 (68.70%) patients received follow up endoscopy, of which 207 (49.4%) had erosions. POEM is highly effective, with>90% patients having an Eckardt score<3 without requirement for additional treatment at 5 years. This is comparable to results of Heller myotomy from expert centers. Patients with a diagnosis of achalasia had lower Eckardt scores after POEM compared to those with other diagnosis.Baseline characteristics, Procedural Parameters and OutcomesView Large Image Figure ViewerDownload Hi-res image Download (PPT)