383 Per Oral Endoscopic Myotomy (POEM), A Five-Year Analysis at UHNM

Abstract Aim Achalasia is a rare but debilitating condition causing dysphagia, regurgitation, weight loss and has a significant reduction in quality of life. Our aim was to assess the success of POEM both as a primary treatment and where previous attempts have failed (i.e.. Following a Hellers procedure). Method A cohort of 80 patients undergoing primary POEM (PP) and a second undergoing POEM post Hellers procedure (PPH) were followed over a 5-year period for procedure success and procedure related complications. Procedure success was determined by a reduction in Eckhard score of below 3 a reduction in the use of proton pump inhibitors (PPI) and no complications. Results The PP cohort had a higher pre procedure Eckhard score of 8 (vs 5 for PPH). 92% of patients in PP group achieved an Eckhard score of <3 (100% after repeat POEM) compared to 100% in PPH. Complications were rare (1% leaks, 1% bleeding and 1% infection) for the PP cohort with no cases for the PPH group. There were two readmissions (PP group) and mortality was zero for both groups. Only 3% of repeat procedures were required (PP group) to achieve symptom control. PPI use was reduced by 8% in PP cohort (from 57% to 49%) but was unchanged in the PPH group (62%). Conclusions PP and PPH are highly effective, achieving excellent symptom control and reduction in use of PPIs in all but the most aggressive cases. It has a low complication rate and is safe even when previous attempts at treatment have failed.