COMPARISON OF PERORAL ENDOSCOPIC MYOTOMY BETWEEN DE-NOVO ACHALASIA AND PRIOR TREATMENT FAILURE ACHALASIA

Aims Peroral endoscopic myotomy (POEM) has been recognized as an effective treatment for patients with achalasia. Prior treatment can affect the outcome of subsequent treatment. We aimed to compare the safety and efficacy of POEM in treatment-naive patients vs. those with prior treatment failure (PTF).

Methods We analyzed achalasia patient’s data underwent POEM from November 2011 to January 2018, retrospectively. A comparative analysis was performed between treatment-naive and PTF cases. Technical and clinical success, adverse events, and operative time for POEM were compared between the two groups.

Results Overall, 209 patients with achalasia underwent POEM during the study period: 113 patients (54%) in the de-novo group and 96 patients (45%) in the PTF group. Changes in Eckardt score before and after POEM (5.11 ± 0.23 vs. 4.99 ± 0.253; P=0.042 vs P=0.001) were comparable in the treatment-naïve and PTF cases, respectively. Operative time was longer in the PTF group than in the de novo group, but not statistically significant. Occurrence of gas-related events and severe complications were similar in both groups. The operation time, hospital stay, length of myotomy were not significant different in both groups.

Conclusions POEM is safe and equally effective for de-novo patients and for those in whom prior treatment has failed. POEM should be considered the treatment of choice in patients in whom prior treatment has failed.