Jagpal S. Klair, MD1, Yazan Hasan, MBBS2, Maen Masadeh, MD3, Henning Gerke, MD4, Arvind Murali, MD4, Kalpaj Parekh, MD4, John Keech, MD4, Peter Nau, MD4, Rami El Abiad, MD4
1Digestive Diseases Institute, Virginia Mason Clinic, Seattle, WA; 2University of Iowa Hospitals & Clinics, North Liberty, IA; 3University of California San Francisco Medical Center, San Francisco, CA; 4University of Iowa Hospitals & Clinics, Iowa City, IA
Introduction: Peroral endoscopic myotomy (POEM) has been proven to be effective for treating esophageal dysmotility disorders. Herein is a report of the safety and efficacy of POEM in patients aged ≥65 years at an academic US tertiary care center.
Methods: Medical charts of all patients aged ≥65 years that underwent POEM between December 2014 and October 2018 were retrospectively reviewed. Demographic data, clinical data and treatment outcomes were obtained. POEMs were performed by multidisciplinary teams each including 1 of 2 endoscopists (HG,RE) and 1 of 3 surgeons (KP,PN,JK). Clinical success was defined as Eckardt score ≤ 3 and improvement of symptoms.
Results: During the study period, 62 patients were included. The mean age of patients was 72.3 ± 5.7 years (range 65-89 years; 42% women). Mean BMI was 29.8 kg/m2. Indications for POEM included Achalasia 88.7%, diffuse esophageal spasm (DES) 6.5%, Jackhammer esophagus 3.2% and esophagogastric junction outflow obstruction (EGJOO) 1.6%. There were 2 intraoperative complications documented (pneumothorax and anaphylaxis to medication). Mean pretreatment IRP was 24.1. Pretreatment Eckardt score was 6.98 ± 2.2 compared with posttreatment Eckardt score of 1.25 ± 2 (p< 0.05). Clinical success (Eckardt score ≤3) was achieved in 88.7% of patients. Mean myotomy length 13.8 cm (posterior orientation of myotomy 75.8%). Median hospitalization duration was 1.9 days. Postoperative complications included 1 patient with esophageal leak on postoperative esophagram, 1 patient with esophageal stricture, and 1 patient with both stricture and leak. No deaths occurred. Six patients with persistent symptoms post POEM required through-the-scope dilation to achieve improvement in symptoms.
Discussion: POEM can be safely carried out in symptomatic elderly patients ≥ with esophageal dysmotility disorders. An excellent clinical response (88.7%) was noted in this patient cohort.
Citation: Jagpal S. Klair, MD; Yazan Hasan, MBBS; Maen Masadeh, MD; Henning Gerke, MD; Arvind Murali, MD; Kalpaj Parekh, MD; John Keech, MD; Peter Nau, MD; Rami El Abiad, MD. P0277 - SAFETY AND EFFICACY OF PERORAL ENDOSCOPIC MYOTOMY (POEM) IN PATIENTS ≥65 YEARS AT A SINGLE ACADEMIC TERTIARY CARE CENTER. Program No. P0277. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.