Background and Aims
Per-oral endoscopic myotomy (POEM) for achalasia is particularly appealing in the
elderly because it is minimally invasive. However, data in patients aged ≥80 years
are scarce. The aim of this study was to assess the clinical outcome of POEM in octogenarians.
Methods
This was a multicenter retrospective study at 8 centers. Consecutive octogenarians
with achalasia who underwent POEM between 2010 and 2016 were included. Rates of technical
success (completion of myotomy), clinical response (Eckardt score ≤3), and adverse
events (severity graded as per American Society for Gastrointestinal Endoscopy lexicon)
were assessed.
Results
A total of 76 patients (47.4% female, mean age 84 years) underwent POEM for treatment
of achalasia: type I, 17.1%; type II, 35.5%; type III, 17.1%; and unspecified, 30.3%.
Overall, 41.1% were treatment naïve, whereas others had previous botulinum toxin injection
and/or pneumatic dilation. The mean (± standard deviation [SD]) age-adjusted Charlson
comorbidity index score was 6.2 ± 2.4, with the majority of patients having American
Society of Anesthesiologists Physical Status Classification System (ASA) scores of
II/III. Technical success was 93.4%, with a median follow-up of 256 days. Fourteen
adverse events occurred in 11 patients (14.5%). There were 3 inadvertent mucosotomies,
6 cases of symptomatic capnoperitoneum and/or capnomediastinum, 2 esophageal leaks,
1 cardiac arrhythmia, and 2 other). The severities of these adverse events were mild
(78.6%), moderate (14.3%), and severe (7.1%). Clinical success was achieved in 90.8%
of patients, with a mean (± SD) Eckardt score reduction from 7.0 ± 2.3 to 0.8 ± 0.1
(P < .001), a median follow-up of 256 days, and interquartile range of 66 to 547.
Conclusion
Although the rate of technical success may be somewhat lower and the rate of adverse
events slightly higher than previously reported, our data suggest that POEM in octogenarians
is safe and effective, supporting its role as a primary modality for achalasia in
this patient population.
Abbreviations:
ASA (American Society of Anesthesiology Physical Status Classification System), ASGE (American Society for Gastrointestinal Endoscopy), BT (botulinum toxin), POEM (per-oral endoscopic myotomy)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 21, 2017
Accepted:
February 10,
2017
Received:
November 13,
2016
Footnotes
DISCLOSURE: M. Khashab is a consultant for Boston Scientific. S. Roman has served as consultant for Medtronic and Sandhill Scientific. All other authors disclosed no financial relationships relevant to this publication.
Identification
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© 2018 by the American Society for Gastrointestinal Endoscopy
