Sa1295 POEM FOR TREATMENT WITH ESOPHAGEAL DYSMOTILITY IN PATIENTS IN PATIENTS WITH PRIOR BARIATRIC SURGERIES: A MULTICENTER EXPERIENCE

Peroral endoscopic myotomy (POEM) in patients with esophageal dysmotility who have previously undergone bariatric surgery can be challenging due to extensive adhesions and altered anatomy. Outcomes of POEM in patients with prior bariatric surgeries has not been well studied. The aim of the study was to analyze the outcomes of POEM in management of esophageal dysmotility in patients who have previously undergone bariatric surgeries. This is a multicenter retrospective study of prospectively maintained databases at two tertiary referral centers from 2015-2019. Patients with prior bariatric surgery who underwent POEM for treatment of esophageal dysmotility disorders (Achalasia or EGJOO) were included. Primary outcome of the study was clinical success, which was defined as a post-treatment Eckardt score ≤ 3 or improvement in Eckhart score by ≥1 when baseline Eckhart was <3, and improvement of symptoms. Secondary outcome was rate of adverse events. A total of 10 patients with prior bariatric surgery [RYGB (8) or sleeve gastrectomy (2)] underwent POEM in the study period. Indications included Achalasia I (1), II (3), III (5) or EGJOO (1). All procedures were done with anterior myotomy approach. Mean IRP of the patients was 23.3 ± 5.5 mmHg. Pre- and post-procedure Eckardt scores were 6.7 ± 2.1 and 1.6 ± 2.1 respectively. Mean total myotomy length was 9.6 ± 3.5 cm including mean myotomy length beyond GEJ of 2.6 ± 1.4 cm. Clinical success rate was 80% (8/10). There were three adverse events (mucosal damage in 2 patients and leak on post-procedure esophagram in 1 patient). These adverse events were managed endoscopically. Mean length of hospital stay was 1.5 ± 0.6 days. No post-procedure GERD was noted in the patients. Dysphagia recurred in 1 patient, which was successfully treated with pneumatic dilation. POEM appears to be safe and effective in management of esophageal dysmotility in patients with prior bariatric surgery (RYGB and sleeve gastrectomy). Prior bariatric surgery does not seem to influence the effectiveness of POEM in this patient population.Table 2Procedure characteristics of post bariatric surgery patients undergoing POEM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)