OBJECTIVELY CONFIRMED GASTROESOPHAGEAL REFLUX DISEASE (GERD) APPEARS HIGHER IN SPASTIC MOTILITY DISORDERS FOLLOWING PER ORAL ENDOSCOPIC MYOTOMY (POEM)
Edward Whitfield*, Marc A. Ward, Steven G. Leeds
Surgery, Baylor University Medical Center, Dallas, TX
Introduction: Per Oral Endoscopic Myotomy (POEM) is a promising minimally invasive therapy in the treatment of achalasia and other esophageal motility disorders. This study was designed to report outcomes, including objective data in patients with at least 6 months follow-up.
Methods: Patients who underwent POEM between January 2015 and December 2018 were prospectively followed in an institutional review board-approved database. All patients were invited for a full comprehensive workup 6 months post-POEM including symptom scores, pH testing, manometry and esophagogastroduodenoscopy (EGD). Statistical significance to preoperative values were determined using paired T-tests.
Results: There were 37 patients that met study criteria (median age 56). Indications for POEM include 19 type I achalasia, 6 type II achalasia, 7 type III achalasia and other spastic esophageal motility disorders, and 5 esophagogastric junction outflow obstruction. For all patients mean Eckardt scores post-POEM was 1.8 compared to 7.4 pre-POEM (p < 0.05). a total of 42% (16/38) of patients agreed to undergo pH testing following POEM. Of those 8/16 patients had an abnormal DeMeester score (>14.72). Grade C/D esophagitis was observed in 19% (5/26) patients on upper endoscopy. The incidence of PPI use post-POEM was 50% (7/14). The incidence of GERD appears to be highest in patients who undergo POEM for type 3 and other spastic achalasia disorders (42%). Average myotomy length for type 3 achalasia and other spastic motility disorders was 14.4 cm ( range 8-20 cm) compared to 7.45 cm (6-10 cm) for all non-spastic disorders.
Conclusions: POEM provides symptomatic relief and reduced Eckardt scores in patient with achalasia and other esophageal motility disorders. Approximately 50% of patients who undergo POEM develop objectively confirmed GERD. Patients with type 3 achalasia and other spastic motility disorders are at highest risk for developing reflux, which may be attributed to the longer myotomy length.
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