Abstract
666 WHAT TO DO WHEN HELLER MYOTOMY FAILS? INTERNATIONAL MULTICENTER COMPARATIVE STUDY ON THE OUTCOMES OF REDO HELLER MYOTOMY VS PERORAL ENDOSCOPIC MYOTOMY VS PNEUMATIC DILATATION IN PATIENTS WITH FAILED HELLER MYOTOMY
Gastrointestinal endoscopy, Vol.91(6 Supplement), pp.AB56-AB56
06/2020
DOI: 10.1016/j.gie.2020.03.316
Abstract
Background
Heller myotomy (HM) is highly effective for achalasia treatment. Nonetheless, recurrent/persistent symptoms occur in 10–20% of patients. Management options include POEM, redo-HM, or pneumatic dilatation (PD). It is currently unknown which of these options is more effective.
Aims
To compare the efficacy and safety of POEM, redo-HM, or PD in patients with previous failed HM.
Methods
This was an international experience at 14 centers between 10/2010 and 11/2019. Adults with failed HM who underwent POEM, redo-HM, or PD were included. Technical success was defined as successful completion of the procedure. Clinical success was defined as a decrease in Eckardt score (ES) to ≤3 without the need for reinterventions. Adverse events (AEs) were graded according to the ASGE Lexicon/Clavien-Dindo classification.
Results
A total of 162 patients (51% F, mean age 54yr) with failed HM were included, of whom 108 underwent POEM, 23 redo-HM, and 31 PD. The baseline mean ES was 6.1, 6.6 and 6.2 (p=0.6), and baseline mean integrated relaxation pressure was 18.7, 16.1 and 22.0 (p=0.5). Technical success was achieved in all patients. After a mean follow up of 16.9 months (14.4 POEM, 26.0 redo-HM, 18.4 PD), the POEM group had the lowest mean post treatment ES (1.8 vs 4.4 vs 5.0, p<0.001) and rate of clinical relapse (11.7% vs 68.1% vs 48.2%, p=0.02). At 6-12 months follow up, clinical success was achieved in 90% of POEM patients, 60% redo-HM, and 50% PD (p=0.01), and higher in the POEM group vs redo-HM (OR 6.01, p=0.03). At 12-24 months follow up, 83.3% of POEM patients, 40% redo-HM, and 28.5% PD remained in clinical success (0.004), which was higher in the POEM group vs redo-HM (OR 4.5, p=0.001) and lower in the PD group vs POEM (OR 0.17, p=0.01). In patients with >24 months follow up (n=41, mean 38.6 mo), 72.7% of POEM patients, 40% redo-HM and 22% PD remained in clinical success (p=0.03), which was higher in the POEM group vs redo-HM (p=0.07), and lower in the PD group vs POEM (OR 0.11, p=0.02). Patients who underwent redo-HM experienced more AEs (26% vs 8% POEM vs 13% PD, p=0.05). Based on Clavien-Dindo/ASGE Lexicon, redo-HM group experienced more grade 3 and 4 AEs (13% vs 1% POEM vs 0% PD, p=0.02) and more severe AEs (9% vs 0% PEOM vs 0% PD; p=0.007). The PD group had the shortest mean procedure time (31.1 min, p<001) and LOS (p<0.001). The redo-HM group had longer procedure duration (167 vs 84 min, p<0.001) and LOS (5 vs 2 d, p<00.1), compared with the POEM group (Table 1). Univariable logistic regression analysis demonstrated that patients who underwent retreatment with POEM have a higher likelihood of achieving clinical success compared with redo-HM (OR 7.6, p<0.001) (Table 2).
Conclusion
POEM results in higher short/mid-term clinical success and lower rate of clinical relapse compared with alternative treatments in patients with failed HM.
Details
- Title: Subtitle
- 666 WHAT TO DO WHEN HELLER MYOTOMY FAILS? INTERNATIONAL MULTICENTER COMPARATIVE STUDY ON THE OUTCOMES OF REDO HELLER MYOTOMY VS PERORAL ENDOSCOPIC MYOTOMY VS PNEUMATIC DILATATION IN PATIENTS WITH FAILED HELLER MYOTOMY
- Creators
- Nasim Parsa - University of Missouri Health SystemRintaro Hashimoto - University of Missouri Health SystemMikhail Attaar - University of Missouri Health SystemNikolas P. Eleftheriadis - University of Missouri Health SystemChen-Shuan ChungSimon Hew - University of Missouri Health SystemJose Nieto - University of Missouri Health SystemElena Finati - University of Missouri Health SystemGaia Pellegatta - University of Missouri Health SystemFermin Estremera-ArevaloSwati Pawa - University of Missouri Health SystemAndrew S. Nett - University of Missouri Health SystemNikhil A. Kumta - University of Missouri Health SystemYutaka Tomizawa - University of Missouri Health SystemQais M. Dawod - University of Missouri Health SystemManol Jovani - University of Missouri Health SystemGeri KeaneYervant IchkhanianSarah S. Al Ghamdi - University of Missouri Health SystemThomas M. Runge - University of Missouri Health SystemMohamad Aghaie MeybodiSahiljeet Singh - University of Missouri Health SystemReem Z. Sharaiha - University of Missouri Health SystemDavid L. Carr-LockeRishi Pawa - University of Missouri Health SystemEduardo Albeniz - University of Missouri Health SystemRoberta Maselli - University of Missouri Health SystemRobert Bechara - University of Missouri Health SystemMichael Ujiki - University of Missouri Health SystemKenneth J. Chang - University of Missouri Health SystemMouen A. Khashab - University of Missouri Health System
- Resource Type
- Abstract
- Publication Details
- Gastrointestinal endoscopy, Vol.91(6 Supplement), pp.AB56-AB56
- DOI
- 10.1016/j.gie.2020.03.316
- ISSN
- 0016-5107
- eISSN
- 1097-6779
- Language
- English
- Date published
- 06/2020
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984697056402771
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