Su1017 POEM FOR ESOPHAGOGASTRIC JUNCTION OUTFLOW TRACT OBSTRUCTION: AN INTERIM MULTICENTER STUDY

Esophagogastric junction outflow obstruction (EGJOO) is a rare but increasingly recognized, newly described disorder typically presenting with dysphagia and chest pain. On manometry it is characterized by failure of the lower esophageal sphincter (LES) to relax with wet swallow reflected by an elevated integrated relaxation pressure (IRP), yet with some preserved esophageal peristalsis, thus not fulfilling the diagnostic criteria for achalasia. At present there is no well-defined management algorithm thus pharmacotherapy, botulinum toxin injection, pneumatic dilation, and surgical myotomy are all used in everyday care with mixed results. Since the best management strategy for EGJOO remains unclear and LES targeted therapies appear to provide some benefit we aimed to evaluate the safety and efficacy of peroral endoscopic myotomy (POEM) for the treatment of patients with symptomatic EGJOO. An international multicenter retrospective cohort interim analysis of patients with symptomatic EGJOO that underwent POEM between February 2014 and September 2019. There were five centers, four from the United States and one from Italy. Rates of technical success (completion of POEM), clinical response (post-POEM Eckardt score £3) and adverse events (severity based on ASGE lexicon) were evaluated. 40 EGJOO patients underwent POEM during the study period. Mean age was 60.2 (IQR 48-74.25) years, and 22 were female. The average duration of symptoms prior to POEM was 69.15 months (IQR 24-120 months). Nineteen patients (47.5%) had failed one or more prior treatments prior to POEM (5 pharmacotherapy, 10 botulinum toxin injections, 10 pneumatic dilation). None of the patients had prior surgical treatment. Mean baseline ( SD) Eckardt score was 7.32 2.73 and the mean integrated relaxation pressure (IRP) was 29.9 29.2 mm Hg. Technical success was achieved in all 40 patients (100%) with mean procedure time ( SD) of 77 39.9 minutes. Clinical success was attained in 36 patients (94.7%) at a median follow-up of 108 days. There were only 3 adverse events (7.5%), including 2 mild adverse events (pneumoperitoneum) requiring intraprocedural decompression with full recovery and 1 severe adverse event (mucosal perforation) successfully closed endoscopically with esophageal stent placement. Our initial experience suggests that POEM is safe and highly effective therapy in patients with symptomatic EGJOO. Our findings support further larger scale investigation.