SAFETY AND EFFICACY OF PERORAL ENDOSCOPIC MYOTOMY FOR ACHALASIA: A CANADIAN EXPERIENCE

Aims Evaluate the outcomes of POEM in our center.

Methods Retrospective analysis on consecutive patients who underwent POEM for achalasia between July 2017 and September 2019. The primary end point is the reduction of the Eckardt Score after POEM by 3 points. Secondary end points are adverse event rate, duration of hospital stay.

Results Twenty-eight patients (mean age 62±13 yo, 57% men) underwent POEM at our center during the study period. Most of patients had type 1 (n=12) or type 2 achalasia (n=10), and 6 had other dysmotility disorders. The average length of symptoms was 7.7 years (1-34). The average Eckardt score pre-POEM was 7.1 ± 2.4 (3-12). Technical success was achieved in 96% (n=27). One procedure failed because of mucosal perforation. Average duration of procedure was 85 ± 34 minutes (34-155). Length of myotomy were in average 11.2 cm. Most adverse events occurred during the procedure: bleeding and subcutaneous emphysema in 16 patients (57%) respectively, and pneumoperitoneum in 12 patients (43%). One patient had pneumothorax drained and admitted at ICU for four days, and one patient had delayed subcutaneous emphysema treated with endoscopic clips. The median length of hospital stay was 2 (2-7). The average Eckardt score at follow up was 1.2 ± 1.8 (0-8). The average Eckardt score variation was −5.9 ± 3.5 (−10-4). Twenty-five patients (89%) had a reduction by 3 or more of the Eckardt score. There was no difference with the type of achalasia: type 1=100% and type 2=90%.

Conclusions Our data suggests that POEM is a promising procedure to improved patient with achalasia with a relatively low risk of complication and length of hospital stay.