S2282 Early Experiences Show Safe and Effective Treatment With Per-Oral Plication of the Esophagus (POPE)

Introduction: The peroral plication of the esophagus (POPE) is a minimally invasive endoscopic procedure that aims to treat esophageal motility disorders such as achalasia and dysphagia that have resulted in sump formation. The technique utilizes endoscopic suturing to modify the esophageal lumen and improve functionality, offering a less invasive alternative to traditional surgical interventions. Our study aims to evaluate the safety and efficacy of the POPE procedure. Methods: This single-center retrospective pilot study included patients undergoing POPE from June-November 2024 at a tertiary academic center. Preprocedural assessments included upper endoscopy and high-resolution manometry or CT. A dual-channel endoscope was used with Rat Tooth forceps for mucosal grasping and Apollo Overstitch for running “U” pattern sutures placed distal to proximal. Post-procedural esophagrams evaluated for leaks/perforations. Primary outcomes include clinical success (procedure completion) and technical success (sump plication), while secondary outcomes focused on post-procedural Eckardt score improvement. Results: A total of 8 patients underwent a POPE procedure. The mean age was 64.6, with the majority (62.5%) being woman and an average BMI of 25.9. All patients had achalasia, dysphagia, and GERD as active symptoms. Six (75%) patients had previous pneumatic dilations and 5 had a prior Heller myotomy. On average, the time between the achalasia diagnosis and the POPE procedure was 14 years, with a wide range of 4 days to 44 years. Five (62.5%) patients had the procedure at the same time as a peroral endoscopic myotomy (POEM). The average procedure time was 40 minutes with a mean sump length of 8.1 cm, and 4 sutures placed. All patients reported immediate symptomatic improvement and no immediate adverse events and had post-procedural esophagrams to check for leaks or perforations. There was a 100% clinical and technical success rate. The average pre-procedure Eckardt score was a 9.2, and the post procedure Eckardt score was a 1. Conclusion: This preliminary study provides valuable insights into the safety and efficacy of peroral plication of the esophagus in managing esophageal motility disorders associated with sump formation. The procedure was well-tolerated, achieving 100% technical and clinical success rates with no immediate adverse events and significant symptomatic improvement. Given these favorable outcomes, further studies with larger sample sizes and long-term follow-ups are warranted.