PERORAL ENDOSCOPIC MYOTOMY (POEM) FOR ACHALASIA: A EUROPEAN MULTICENTER SURVEY ABOUT CLINICAL PRACTICE

Aims:

POEM is an established treatment for achalasia. However, the peri-operative management remain heterogeneous. Thus, we propose this survey was to assess the clinical practice in various European expert centers.

Methods:

French and European centers performing POEM routinely were proposed a 4 parts online survey (Google Forms) about their practice around POEM for achalasia: 1/Pre-procedure evaluation; 2/Indications; 3/Procedural technique; 4/Follow-up.

Results:

Twenty-one centers responded, with a mean of 28 POEM/operator/year [8 – 70]. The pre-operative assessment always includes Eckardt score, gastroscopy and high resolution manometry (HRM), and BMI in 62%. POEM is indicated in 1st intention in 100% of centers for type III achalasia, 81% for type I, and 76% for type II. It is performed in 95% after failure of Heller, 81% in high Eckardt score and young men. After previous dilation, 45% indicate POEM after one session of any diameter. The two main contra-indications are paraneoplastic achalasia (71%) and systemic diseases (52%).

All patients are hospitalized. Procedures are performed under anesthesia and intubation, in supine position (90%). Patients receive antibiotic prophylaxis in 86%. A regular endoscope is mostly used always with CO2. The most used knife is the Triangle (Olympus, Japan). The tunnel is likely posterior (86%) with a mean length of 13.6 cm [10 – 17]. The myotomy is anterograde in 81% (mean length: 10 cm [6 – 15]). The mean procedure time is 55 min [25 – 100].

Post-operatively, patients resume liquids from POD 1 in 81%. The mean hospital stay is 2.2 days [1 – 5]. Patients always have oral PPI, resume antiplatelets and anticoagulants after 3 and 6 days, respectively. The median of reevaluation is 3 months (100% Eckardt score, 76% BMI). A HRM is performed in 52%. Patients are mostly followed annually (71%).

Conclusions:

Despite its place in the treatment of esophageal motor disorders, the policy of management differs among European expert centers.