World Congress at ACG2017

Simultaneous Plenary Session 4B: Esophagus / Colon

71 - Following Peroral Endoscopic Myotomy (POEM) Gastroesophageal Reflux (GERD) Is Frequent and Is Associated With Increased Esophagogastric Junction Distensibility Measured by EndoFLIP

Wednesday, October 18
9:50 AM - 10:00 AM
Location: Valencia Ballroom D (Level 4)



Category: Esophagus       

Jennifer Horsley-Silva, MD, Norio Fukami, MD, Michael D. Crowell, PhD, MACG, AGAF, Marcelo Vela, MD
Mayo Clinic, Scottsdale, AZ
Introduction: POEM is emerging as a useful achalasia treatment. Data regarding the rate of post-POEM GERD are limited. Our aim was to characterize the incidence of post-POEM reflux by objective parameters.

Methods: Retrospective review of a prospectively maintained database of patients treated with POEM for esophageal motility disorders at a single center. Patients with prior myotomy or fundoplication, and those who underwent LES-sparing POEM were excluded. Data collected included (a) demographics, symptoms, Eckardt score, and manometric diagnosis at presentation, (b) findings at the 3-month follow-up: symptoms, Eckardt score, EGD findings, EG junction distensibility index (DI) by endolumenal functional lumen imaging probe (EndoFLIP), high resolution esophageal manometry (HREM), and reflux monitoring by 48 hour wireless pH monitoring off PPI for ≥7 days or 24-hour pH-impedance on PPI. GERD was defined by erosive esophagitis LA grade B or greater on EGD, or abnormal reflux monitoring (% time pH57 reflux episodes on pH-impedance). Data are presented as mean (SD) or n (%).

Results: 19 patients were included; mean age 58 years (16.5), 53% male, mean BMI 28.8 (6.3), baseline mean Eckardt score was 6.8 (1.7). Manometric diagnosis were 2 (10.5%) Achalasia type I, 8 (42%) Achalasia type II, 3 (16%) Achalasia type III, 4 (21%) EGJOO, and 2 (10.5%) Jackhammer esophagus.

At 3 month follow-up, mean Eckardt score decreased from 6.8 to 1.8. 10 of 17 (59%) reported heartburn. 12 (63%) patients had objective evidence of GERD: 5 by wireless pH, 1 by pH-impedance, 2 by EGD, and 4 by both EGD and wireless pH. Mean DI at 30 ml by EndoFLIP was higher in patients with versus without GERD (6.0 vs 3.8; p=0.031) (Image 1). GERD was uniformly present when distensibility index was >6. There were no significant differences in post-treatment (3-month) DI at 40 ml or 50 ml, or resting LES pressure for GERD vs no GERD (Table 1).

Discussion: POEM is an effective treatment. Objectively documented GERD is frequent at 3-month follow-up. Increased EG junction DI by EndoFLIP can help identify patients at risk for GERD. Our results highlight the need to test for GERD after POEM and treat it when present, in order to prevent potential reflux-related long term complications. Additional data will be needed to clarify clinical significance, response to PPI, and impact of GERD in a larger cohort of patients with longer follow-up. Data collection is ongoing.

Supported by Industry Grant: No


Evaluation of EGJ Post-POEM in Patients with versus without GERD































  EndoFLIP Distensibility at 30 ml EndoFLIP Distensibility at 40 ml EndoFLIP Distensibility at 50 ml Mean LES Pressure on Manometry
GERD Positive 6.0 (3.0) 6.6 (3.0) 5.5 (2.3) 16.7 (11.7)
GERD Negative 3.8 (0.9) 5.2 (1.5) 4.7 (2.0) 22.5 (10.5)
P-value 0.031 0.185 0.445 0.284

Scatter plot of 3 month post-POEM DI at 30 ml in patient with GERD versus those without GERD.

Citation: . FOLLOWING PERORAL ENDOSCOPIC MYOTOMY (POEM) GASTROESOPHAGEAL REFLUX (GERD) IS FREQUENT AND IS ASSOCIATED WITH INCREASED ESOPHAGOGASTRIC JUNCTION DISTENSIBILITY MEASURED BY ENDOFLIP. Program No. 71. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.

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71 - Following Peroral Endoscopic Myotomy (POEM) Gastroesophageal Reflux (GERD) Is Frequent and Is Associated With Increased Esophagogastric Junction Distensibility Measured by EndoFLIP



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