Early Experience with Peroral Endoscopic Myotomy (POEM) in an Elderly Cohort

Matthew Zapf, BA, Amy Yetasook, BA, JoAnn Carbray, RN, Michael Ujiki, MD

NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine

INTRODUCTION – Peroral endoscopic myotomy (POEM) is a promising natural orifice modality for symptomatic esophageal achalasia, but little has been reported about POEM in elderly patients. We examined perioperative outcomes in elderly patients who received POEM.

METHODS AND PROCEDURES- We mined institutional review board-approved prospective POEM and retrospective esophageal databases. A single surgeon performed Laparoscopic Heller Myotomy (LHM) with partial fundoplication or POEM on patients with symptomatic achalasia from July 2010 to August 2012. Elderly patients were defined as ≥70 YO and adult patients were ≥18 and <70 YO. SF-36, Eckardt, GERD, and dysphasia scores were collected pre- and post-operatively. Unpaired T-tests were used to analyze normally distributed data.

RESULTS– Thirteen POEM patients were included, of which, five were elderly (81.2 ± 7.3 YO) and eight adult (50.9 ± 16.4 YO). Comparisons were made with nine elderly LHM patients (76.7 ± 6.3 YO) and ten adult LHM patients (43.1 ± 15.2 YO). All demographics other than age were equivalent between groups. All cohorts had similar pre-op Eckardt scores, symptom duration, and indications for surgery. There was one esophageal perforation in the adult POEM and one in the adult LHM group, both of whom required a return to surgery for drainage. There were no deaths or conversions in either surgical group. Elderly and adult POEM patients had equivalent OR times (179 ± 65 v 188 ± 77 min), as did LHM patients (169 ± 38 v 140 ± 33 min), and there was no difference between surgical groups. Elderly POEM and LHM patients had equivalent length of stay (3.0 ± 1.6 v 3.0 ± 2.1 days), pain measurements by visual analog score (2.8 ± 3.3 v 5.1 ± 2.1 P=0.13) and post-op analgesia in morphine equivalents (9.0 ± 8.3 v 33.6 ± 56.4 mg P=0.23) Three elderly LHM patients went to a skilled nursing or rehab facility after surgery, while all of the POEM patients went home. Post-op Eckardt scores were similar in elderly POEM and LHM patients (0.5 ± 1.0 v 0.6 ± 0.7), with equivalent follow up (147 ± 127 v 120 ± 106 days), and no dysphasia.

CONCLUSIONS – POEM is a safe and feasible option for patients with symptomatic achalasia over 70 years of age. Recovery from POEM seemed to be equivalent despite age. Elderly patients who undergo POEM are less likely to require a skilled nursing facility than patients who underwent Laparoscopic Heller Myotomy.

Session: Poster Presentation

Program Number: P586

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