IDDF2021-ABS-0058 Outcomes of poem in achalasia and non-achalasia motility disorders beyond five-years: a large, single centre study

Background Per-oral endoscopic myotomy (POEM) is an established modality of treatment in achalasia. However, there is limited data on the long-term outcomes of POEM. In this study, we aim to evaluate the efficacy of POEM in patients with a minimum follow-up of five years. Methods The data of patients who underwent POEM and completed at least five-years follow-up were analyzed, retrospectively. The primary outcome of the study was a clinical success (Eckardt≤3) at ≥5-years after POEM. The secondary outcomes included the prevalence of dysphagia and symptoms of gastroesophageal reflux disease (GERD). Multivariate analysis was performed to analyze the predictors of dysphagia and symptomatic GERD on long-term follow-up. Results 319 patients (males 182, mean age 40.5±14.2 years) completed a median of 73 (60-89) months follow-up. The spectrum of motility disorders included idiopathic achalasia (type I 26.6%, type II 60.8%, type III 5.6%) and Jackhammer esophagus or distal esophageal spasm (2.8%). POEM was technically successful in 307 (96.2%) patients. The data for long-term follow-up was available in 283 (88.7%) patients. The overall long-term success was 92.6%, 92.1% (type I), 94.7% (type II), 87.5% (type III) and 75% (Jackhammer esophagus/distal esophageal spasm) (IDDF2021-ABS-0058 Figure 1. Clinical response to POEM at 5-years follow-up on intention to treat and per-protocol population) (IDDF2021-ABS-0058 Figure 2. Change in mean Eckardt score at 1- and 5-years after POEM compared to baseline). Young age was an independent risk factor for the development of dysphagia on follow-up (p=0.037) (IDDF2021-ABS-0058 Table 1). Clinical GERD was detected in 28.6% of patients. On multivariate analysis, female sex was an independent predictor of symptomatic GERD after POEM (p=0.025) (IDDF2021-ABS-0058 Table 2). Conclusions POEM is an effective and durable treatment modality for achalasia and other non-achalasia spastic motility disorders. Young patients and females may be at higher risk for recurrent dysphagia and GERD, respectively.