Experimental Medicine, Prague, Czech Republic; 2Transplant Surgery. Department, Institute for Clinical and Experimental Medicine, Prague,. Czech Republic ...
Abstracts
219 Long-Term Results of Peroral Endoscopic Myotomy (POEM) for Achalasia Zuzana Vackova*1, Hana Svecova2, Ondrej Ngo3, Julius Spicak1, Petr Stirand1, Eva Kieslichova4, Alexandr Pazdro5, Jan Martinek1 1 Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; 2Transplant Surgery Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; 3Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic; 4Department of Anesthesiology and Intensive Care, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; 5Department of Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic Background and aims: Peroral endoscopic myotomy (POEM) has gained trust by proved safety and short-term efficacy and at present, it may be considered as a standard method for treatment of esophageal achalasia. However, long-term data concerning both the efficacy and safety with a special attention to post-POEM reflux are still awaited. The aim of this prospective case series was to assess the long-term clinical outcome of POEM with emphasis on post-POEM reflux evaluated by pH monitoring, endoscopy findings, reflux symptoms and use of proton pump inhibitors (PPIs). Methods: Since 2012, a total of 167 patients with achalasia (74 women, 93 men, mean age 48) underwent 174 POEM procedures. Follow-up visits at 3, 12, 24 and 36 months were completed in 159, 111, 64 and 30 patients. Upper GI endoscopy, high-resolution manometry and 24-hour pH monitoring were performed 3 months after POEM; endoscopy was then repeated between 24-36 months. Main outcomes were treatment success defined as an Eckardt score < 3, recurrence rate and post-POEM reflux. Results: At 3, 12, 24 and 36 months after POEM, treatment success was achieved in 97% (95% CI: 93-100), 92% (CI 90-98), 90% (CI 85-97) and 83% (CI 75-94) of patients. The median Eckardt score decreased from 7 before POEM to 0 at 3, 12, 24 and 36 months; p
