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ENDOFLIP TAILORED SELECTIVE CIRCULAR POEM REDUCES SHORT TERM POST-PROCEDURAL GASTRO-ESOPHAGEAL REFLUX DISEASE SYMPTOMS IN TREATMENT NAÏVE PATIENTS BUT NOT IN PREVIOUSLY TREATED

Theodoros Voulgaris 1, Homira Ayubi 1, Olaolu Olabintan 2, Marie-Anne Norreilie 1, Mehul Patel 1, Sri Trumurthy 1, Shraddha Gulati 1, Amyn Haji 1, Bu Hayee 2

Affiliations

1 King’s College Hospital, London, United Kingdom

2 Kings College Hospital, London, United Kingdom

Summary

AI Generated

In 96 achalasia patients undergoing POEM, short-term GERD developed in 18.7% overall, with previous treatment independently predicting GERD (OR 7.4) rather than whether the procedure was EndoFLIP-tailored.

GERD occurred in 18.7% of patients at 3 months post-POEM and did not differ significantly between EndoFLIP-tailored (21.1%) and non-tailored (17.2%) procedures.
Previous treatment was the only independent predictor of GERD on multivariate analysis (OR 7.412, p=0.004), with rates of 26.8% in treated versus 12.7% in treatment-naïve patients.
Among tailored-POEM patients, previously treated patients had significantly higher GERD rates than naïve patients (42.9% versus 8.3%, p=0.034), whereas no such difference existed in the non-tailored group.
Higher baseline distensibility index correlated with GERD development in tailored-procedure patients (2.9±1.7 versus 2.0±1.5, p=0.038), but myotomy length and approach (anterior versus posterior) did not correlate with GERD.
This study is relevant to endoscopists performing POEM who wish to understand GERD risk stratification, particularly in patients with prior achalasia treatments.

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Abstract

Introduction

Approximately 1/3 patients submitted to Per Oral Esophageal Myotomy (POEM) will develop Gastro-esophageal Reflux (GERD) Symptoms. Several technical characteristics of the procedure and recently Endoluminal functional luminal imaging probe (EndoFLIP) data have been correlated to it.

Aims & Methods

We aimed to evaluate the rate of short-term GERD development among patients submitted to EndoFLIP tailored or not POEM. We included consecutive patients submitted to POEM from 11/2015 to 2/2023. GERD development was assessed by the GERD health-related quality of life (GERD-HRQL) questionnaire and considered positive if ≥13. Patients were evaluated at 3-months post-POEM.

Results

We included 96 patients (M/F: 57/39 mean age: 48 min: 17 - max: 78). Achalasia type distribution was 1/2/3/unclassified: 24/68/1/3. Treatment naïve/experienced were 55/41 .In tailored procedure were submitted 38 while in non-tailored 58 patients. Mean pre-procedural Eckardt score was 7±2 while mean pre-procedural distensibility index (DI) was 2.2±1.6. Anterior approach was selected in 77 while posterior in 19 patients and did not differ between tailored (33/38, 86.8%) vs non-tailored POEM (44/58, 75.9%, p=0.295) while the mean length of myotomy was 10.6±3.4 cm but differed (9.3±2.9 11.4±3.4, p=0.02). GERD was diagnosed in 18/96 (18.7%) and did not differ when comparing tailored vs non-tailored procedure (8/38, 21.1% vs 10/58, 17.2%, p=0.790). The rate of GERD was numerically increased in previously treated vs naïve patients (11/41, 26.8% vs 7/55, 12.7%, p=0.113). When isolating patients with non-tailored POEM, GERD rates did not differ among treated vs untreated (5/31, 16.1% in naïve vs 5/27, 18.5%, p=1.000). While in patients with tailored procedure the rate was significantly increased among previously treated vs naïve patients (6/14, 42.9% vs 2/24 8.3 %, p=0.034). Tailored procedure vs non-tailored procedure led to decreased numerically rates of GERD development in naïve patients (8.3% vs 16.1%, p=0.443) and increased numerically rates among previously treated (non-tailored 18.5% vs tailored 42.9%, p=0.140). In the total cohort GERD development was not correlated to the approach (anterior: 14/77, 18.2% vs posterior: 4/19, 21.1%, p=0.750) or the length of myotomy (10.4 ±3.7 vs 10.7 ± 3.4 cm, p=0.768). In patients with tailored procedure only Baseline DI was correlated to GERD development post POEM even if numerical differences were noted as far as post procedural DI and ΔDI were considered (Table 1). ) In the multivariate analysis only previous treatment was correlated to short term GERD development (p=0.004, OR: 7.412 95% CI: 1.890-29.064).

Table 1

	GERD development by GERD-HRQL at 3 months	GERD absence by GERD-HRQL at 3 months	p
IRP baseline (mmHg)	25.4±15.8	23.3±8.3	0.509
DI pre-procedural	2.9±1.7	2.0±1.5	0.038
Eckardt baseline	6±2	7±2	0.245
Length of myotomy (cm)	8.3±2.2	9.5±3.1	0.133
DI post-procedural	5.3±2.7	4.5±2.0	0.241
ΔDI	2.8±1.8	2.4±1.4	0.390

All values expressed as mean ± SD.

Conclusion

Short term GERD symptom development after POEM by selective circular myotomy occurs in 1 out of 5 patients. These rates did not differ among tailored vs non tailored procedure though they were significantly reduced among treatment naïve patients who underwent tailored POEM. Even if DI especially in the pre-procedural setting may predict short term post POEM GERD development in patients submitted to tailored POEM, only experience to previous treatments was independently correlated to development of GERD at 3 months post-POEM as diagnosed by the use of GERD-HRQL.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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EFFECTIVENESS OF HELICOBACTER PYLORI TREATMENTS ACCORDING TO ANTIBIOTIC RESISTANCE: RESULTS FROM THE EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG)

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EFFECTIVENESS OF HELICOBACTER PYLORI TREATMENTS ACCORDING TO ANTIBIOTIC RESISTANCE: RESULTS FROM THE EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG)

Luis Bujanda Fernández de Piérola 1, Olga P. Nyssen 2, June Ramos 1, Dmitry S. Bordin 3, Bojan Tepes 4, Ángeles Pérez-Aísa 5, Matteo Pavoni 6, Manuel Castro-Fernández 7, Frode Lerang 8, Marcis Leja 9, Luis Ricardo Rodrigo Sáez 10, Theodore Rokkas 11, Juozas Kupcinskas 12, Laimas Virginijus Jonaitis 13, Oleg Shvets 14, Antonio Gasbarrini 15, Halis Simsek 16, Perminder Phull 17, György Miklós Buzás 18, Jose Carlos Machado 19, Doron Boltin 20, Lyudmila Boyanova 21, Ante Tonkic 22, Wojciech Marlicz 23, Marino Venerito 24, Liudmila Vologzhanina 25, Galina Fadieienko 26, Giulia Fiorini 6, ELENA RESINA SIERRA 2, Raquel Muñoz González 2, Anna Cano-Catala 27, Luis Hernández Villalba 28, Leticia Moreira Ruiz 29, Pablo Parra 2, Francis Mégraud 30, Colm O'Morain 31, Javier Gisbert 2

Affiliations

1 Biodonostia Health Research Institute, CIBERehd, UPV/EHU, San Sebastián, Spain

2 Hospital Universitario de La Princesa, IIS-IP, UAM, CIBERehd, Madrid, Spain

3 A.S. Loginov Moscow Clinical Scientific Center, Tver State Medical University, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation

4 AM DC Rogaska, Rogaska Slatina, Slovenia

5 Hospital Costa del Sol Marbella, Málaga, Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Marbella, Spain

6 IRCCS AOU S. Orsola-Malpighi, University of Bologna, Bologna, Italy

7 Hospital de Valme, Seville, Spain

8 Østfold Hospital Trust, Grålum, Norway

9 Digestive Diseases Centre, Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia

10 University of Oviedo, Oviedo, Spain

11 Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece

12 Lithuanian University of Health Sciences, Institute for Digestive Research, Kaunas, Lithuania

13 Lithuanian University of Health Sciences, Kaunas, Lithuania

14 National Medical University, Kyiv, Ukraine

15 Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

16 Hacettepe University, HC International Clinic, Ankara, Turkey

17 Aberdeen Royal Infirmary, Aberdeen, United Kingdom

18 Ferencváros Health Center, Budapest, Hungary

19 3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Ipatimup, Faculdade de Medicina do Porto, Porto, Portugal

20 Rabin Medical Center, Sackler School of Medicine, Petah Tikva, Israel

21 Medical University of Sofia, Sofia, Bulgaria

22 University Hospital of Split, Split, Croatia

23 Pomeranian Medical University in Szczecin, The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland

24 University Hospital of Magdeburg, Magdeburg, Germany

25 Gastrocentr, Perm, Russian Federation

26 L.T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine

27 GOES Research Group, Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain

28 Hospital Santos Reyes, Aranda de Duero, Spain

29 Hospital Clínic de Barcelona, CIBERehd, IDIBAPS, Barcelona, Spain

30 Université de Bordeaux, Bordeaux, France

31 Trinity College Dublin, Dublin, Ireland