Outcomes of Peroral Endoscopic Myotomy (POEM) for Treatment of Achalasia in Elderly Patients: A Single Institution Retrospective Cohort Study.

BACKGROUND

POEM has been shown to have excellent safety and efficacy in adults. We report our experience with the POEM for the treatment of achalasia in elderly patients (65 y or older).

METHODS

This is a single-institution retrospective cohort study over a span of 4 years. The primary outcome was clinical success, defined as improvement in dysphagia score to ≤1 without need for a reintervention in the first 6 months. Secondary outcomes included technical success, rate of reintervention, and postprocedural complications.

RESULTS

A total of 51 patients (male 52.9%, mean age: 72.9±6.2 y; range 65 to 91 y) underwent POEM for treatment of achalasia. Most patients [n=27 (52.9%)] had achalasia type II, while 13 (25.5%) had achalasia type I and 11 (21.6%) had achalasia type III. Technical success was achieved in 100% of patients (n=51), and clinical success was achieved in 96.1% of patients (n=49). The median dysphagia score improved significantly from 3 (IQR=1 to 3) preprocedure to 0 (IQR=0 to 0) at the most recent follow-up (P<0.001). Median regurgitation scores also improved from 1 (IQR=0 to 2) preprocedure to 0 (IQR=0 to 0) postprocedure at the most recent follow-up (P<0.001). Reintervention due to recurrence of symptoms was required in 2 patients (3.9%) during a mean length of follow-up of 9 months (range: 1 to 37 mo).

CONCLUSION

POEM is a safe, effective, and durable treatment for all types of achalasia in elderly patients.