INITIAL EXPERIENCE WITH SAME SESSION ENDOSCOPIC FUNDOPLICATION AFTER PER-ORAL ENDOSCOPIC MYOTOMY (POEM+F) - SHORT TERM CLINICAL OUTCOMES FROM A SINGLE CENTER

Aims Post-POEM gastroesophageal reflux (GER) is reported in up to 50% patients. POEM with endoscopic fundoplication (POEM+F) is a novel NOTES procedure combining endoscopic fundoplication with POEM. This study reports feasibility, safety and short-term outcomes after POEM+F especially with reference to prevention of post POEM GER.

Methods Retrospective analysis of a prospectively maintained database of POEM+F for achalasia cardia (AC) over a 10-month period (Feb to Nov. 2019) was performed. Abstracted technical parameters included technical success, procedure duration and additional time for fundoplication. Clinical parameters included adverse events, pre-and post-POEM+F Eckardt scores, GERD-Q score, EGD and 24-hr pH in follow-up.

Results N = 20 (11 males, mean age 40.9 years [18-67]). POEM+F was technically successful in all patients. Mean total procedure time = 77.5 min (55-145) and time for additional fundoplication = 42.5min (30-105). No AEs encountered. All had oral feeds after 24 hours and discharged within 48 hours.Median follow-up = 4 months (IQR 1-10). Dysphagia improved in all [pre-POEM+F Eckardt score - 8.25 (6-10)vs.post-POEM+F score - 1 (0-2)(p=0.001)]. At 1-month follow-up EGD - intact fundoplication wrap -17(85%) patients. GERD-Q scores normal (< 2) in 19/20 (95%), one patient had score of 5 indicating 50% probability of GERD. Grade A esophagitis noted in 3 (15%); in two of these patients EGD revealed loosened wrap. 24-hr pH monitoring at 1 to 3-months in 10 patients showed normal DeMeester’s scores in 9 (90%); one had a high score but had no esophagitis or reflux symptoms. Overall, 16/20 patients (80%) were GERD-free during follow up.

Conclusions POEM+F is a safe procedure with short term follow up demonstrating significant reduction in post POEM GER but long-term follow-up required to validate these results.