PERORAL ENDOSCOPIC MYOTOMY FOR THE TREATMENT OF ESOPHAGEAL MOTILITY DISORDERS: BASELINE CHARACTERISTICS AND PROCEDURAL OUTCOMES IN YOUNG AND ELDERLY PATIENTS

Aims:

Peroral endoscopic myotomy (POEM) has been proven to be effective for treatment of achalasia. There are limited data on efficacy and safety of POEM in elderly patients. We therefore aimed to assess the role of POEM in patients aged ≥65 years.

Methods:

We retrospectively analyzed POEM outcomes in young (≥18≤40 years) and elderly (≥65 years) patients treated between May 2011 and April 2017. Demographic, clinical data and treatment outcomes were compared between the groups.

Results:

204 patients (116 Young Group [YG], 56% male, mean age 31 ± 6.4, and 88 Elderly Group [EG] 44.3% male, mean age 72.2 ± 4.7) were enrolled. Higher prevalence of spastic motility disorders (type III achalasia, Jackhammer esophagus and Distal Esophageal Spasm-DES) was observed in EG (25.9% vs. 8.9 in EG and YG, respectively. p= 0.0041). Patients in YG had more severe symptoms compared to EG (mean Eckardt score 8 ± 2.0 vs. 7.4 ± 2.0 p= 0.0350), with special regard to dysphagia (3 ± 0.2 vs. 2.8 ± 0.5 p= 0.0001) and chest pain (1.3 ± 1 vs. 0.9 ± 0.8 p= 0.0024).

Mean duration of procedure was similar in the groups, although myotomy was longer in EG (12 ± 3 cm vs. 13 ± 3 cm p= 0.0211), likely explained by higher prevalence of spastic disorders in EG.

No significant differences in the rate of adverse events were found. At 6-month and at mean follow-up (24 months for both groups), clinical success (Eckardt score ≤3) was achieved in 96.4% and 96.4% of patients in YG and 96.5% and 95.4% in EG, respectively (p= n.s.). No significant differences in the groups were observed with regard to post-POEM 4sIRP, Gastro-Esophageal Reflux and Esophagitis-rate.

Conclusions:

POEM is a very safe and effective procedure for the treatment of major esophageal motility disorders, also in elderly patients. POEM might be recommended as the first line therapy to elderly achalasia patients.