Ezra N Teitelbaum, MD, Christy M Dunst, MD, Kevin M Reavis, MD, Ahmed M Sharata, MD, Marc A Ward, MD, Steven R DeMeester, MD, Lee L Swanstrom, MD. The Oregon Clinic
Introduction: Peroral endoscopic myotomy (POEM) is a novel procedure for the treatment of achalasia and other esophageal motility disorders. Excellent short-to-medium term results have been reported, but no study has yet described outcomes at 5 years. In this study we examined the long-term clinical outcomes of the initial POEM patients in our series.
Methods: All patients from a single-center who underwent POEM from October 2010 to February 2012 were included. Patients were contacted to obtain current symptom scores (Eckardt and GerdQ) and encouraged to undergo repeat EGD. Symptomatic success was defined as an Eckardt score ≤3 and freedom from reintervention.
Results: Thirty-six patients underwent POEM during the study period. Three were deceased (all unrelated to achalasia) and 6 were lost to follow-up, leaving 27 patients in the study population. Fourteen were female and the median age was 67. Twenty-two patients had achalasia type I or II and 5 had EGJ outflow obstruction with partially preserved peristalsis. Eckardt scores at a median follow-up of 5 years (range 54-70 months) were significantly improved from preoperatively (mean 1.6 vs. 6.3, p<0.001) and the current Eckardt score was ≤3 in 23 patients (85%). Reintervention was necessary in 2 patients (7%): a laparoscopic Heller myotomy for persistent dysphagia in one patient and an endoscopic proximal myotomy extension to treat spastic chest pain in a second. Both reinterventions were successful, with current Eckardt scores of ≤2 in those patients. Overall, 21 patients (78%) were treatment successes, with both an Eckardt score ≤3 and freedom from reintervention at 5 years. Of the patients with prospectively collected Eckardt scores at 6 months, 2 and 5 years (n=20), symptoms were dramatically improved at 6 months (mean 0.6 vs. 6.7 preoperatively) and maintained at 2 years (mean 0.8), but there was a trend towards worsening symptoms at 5 years (mean 1.6, p=0.06 vs. at 2 years). At 5 years, 6 patients (22%) had symptoms suggestive of gastroesophageal reflux (GerdQ>7) and 8 (30%) were taking daily anti-secretory medications. Eleven patients underwent repeat EGD at 5 years, with 2 (18%) showing mild esophagitis (1 LA A, 1 LA B) and 1 with new Barrett’s esophagus without dysplasia.
Conclusions: In this series, representing the longest reported follow-up to date, POEM remains an effective treatment for esophageal motility disorders out to 5 years in most patients. There may be slight symptomatic regression over time in some patients but the need for reintervention was rare.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80636
Program Number: S092
Presentation Session: Plenary 1
Presentation Type: Podium