253 POEM for Spastic Oesophageal Disorders

Abstract Aim This study aims to investigate the technical outcomes as well as clinical outcomes of POEM, which will focus on the efficacy in reducing symptoms, calculated by Eckard score evaluating the prevalence and complications of the procedure. Method A retrospective study was conducted in the hospital which included 13 patients (N = 13) diagnosed with oesophageal spastic disorders and their treatment with POEM. The procedure involved full thickness posterior myotomy of the oesophagus. Pre- and post-procedure symptom severity was assessed using the Eckardt score by Wilcoxon-signed ranked test. The significance level was decided to be p < 0.05. Results Total13 patients were included in the study mean age of 60.46 years ±11.91. 53.8% were female (7 out of 13), while 46.2% were male (6 out of 13). Follow-up duration averaged 17.23 ± 11.14 months. Average length of myotomy was 20.15 cm ±3.57 and procedure times averaged around 116.15±28.69 minutes. Type III Achalasia is the most prevalent condition, with 6 cases (46.15%), Jackhammer Oesophagus 3 cases (23.08%) and a Mixed Type I and III Achalasia and Mixed Type I and II Achalasia, each with 1 case (7.69%). Jackhammer Diverticulotomy was observed in 2 cases (15.38%). Adverse event like needle decompression of capnoperitoneum were in 3(23.1%) of patients. The study showed that 12 patients were followed up, with regular assessments, 1 patient showed no improvement and had gastroesophageal junction holdup, the other had coexistent gastroeresis. Symptom recurrence in (n = 1) patients at 38 months occurred requiring balloon dilatation. The pre-procedure Eckardt score had a mean of 8.92 ±3.45, indicating the severity of the condition while post-procedure, the average score significantly reduced to 2.31 ±2.92 [ p < 0.000**] showing the statistically significant reduction in the symptoms. There was clinical success as Eckard score less than 3 among most of the patients. Conclusions POEM for spastic oesophageal disorders is safe and effective in 11(84.6%) patients in our series and demonstrated significant symptomatic improvement in patients with esophageal motility disorders, with Type III Achalasia being the most prevalent condition. The results of the study showed that POEM is a valuable therapeutic approach, guaranteeing more studies to optimize patient outcomes and reduce adverse events