ASGE oral abstract733 International Multicenter Experience With PerOral Endoscopic Myotomy (POEM) for the Treatment of Spastic Esophageal Disorders Refractory to Medical Therapy
Section snippets
Background
POEM is potentially an ideal endoscopic therapy for refractory spastic esophageal disorders (SED) since it not only allows myotomy of the lower esophageal sphincter (LES) but also of the esophageal body, where the hypertensive contractions occur. Limited data exist on the use of POEM for therapy of these difficult-to-treat disorders.
Aims
To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm (DES), Jackhammer esophagus (JE), or type III (spastic) achalasia.
Methods
All patients who underwent POEM for treatment of SED refractory to medical therapy at 11 centers (5 US, 2 European, 4 Asian) were included. Diagnosis was based on manometric findings. Relevant clinical, manometric, and endoscopic data were abstracted and pre- and post-procedural symptoms (e.g. Eckardt scores) and manometry were recorded. Clinical response was defined by improvement of symptoms and decrease in Eckardt score to ≤3. Adverse events were graded according to the ASGE lexicon's
Results
A total of 68 patients (mean age 58 years, 45.5% Female) underwent POEM for treatment of SED [DES 8 (11.7%), JE 10 (14.7%), type III achalasia 50 (73.52%)]. Chest pain was the major symptom in 44 (65%) patients and 26 (38%) reported it as moderate/severe. POEM was successfully completed in all patients (anterior approach 62, posterior approach 6) with a mean procedural time of 118 minutes (range 43-345). The mean length of the submucosal tunnel was 18.85 cm (range 9-30). The mean myotomy length
Conclusions
POEM offers a logical therapeutic modality for patients with spastic esophageal disorders refractory to medical therapy. Results from this international trial suggest POEM as an effective and safe platform for the treatment of spastic esophageal disorders refractory to medical therapy.