Hailey Canezaro, MS1, Victoria Andrus, 1, Elizabeth Armstrong, BA1, David Okuampa, MD1, Lena Kawji, MD2, Michelle Neice, MD1, Maryam Mubashir, MD1, Shazia Rashid, MD1, Syed Musa Raza, MD1, Nazar Hafiz, MD1, Qiang Cai, MD, PhD, MACG1 1LSU Health Sciences Center, Shreveport, LA; 2Louisiana State University Health Sciences Center, Shreveport, LA
Introduction: High resolution manometry (HRM) is widely applied to evaluate esophageal motor function, resulting in a better recognition of esophageal motility disorders. Ineffective esophageal motility (IEM) is reported in as many as 30% of patients undergoing HRM. It is defined by the Chicago classification as over 50% of swallows being either weak or failed [distal contractile integral (DCI) ≤450 mmHg s cm], while normal lower esophageal sphincter relaxation is preserved [normal integrated relaxation pressure (IRP)]. Treatment for IEM is challenging. We report short term outcome of POEM on patients with IEM.
Case Description/Methods: We retrieved all patients with the diagnosis of IEM who underwent POEM in our endoscopic center. All of them had extensive work up for their dysphagia, mainly including upper gastrointestinal endoscopy and HRM before referred to us. IEM was diagnosed by their HRM. All of them had gastroesophageal reflux symptoms (GERD) in addition to dysphagia and were taking proton pump inhibitors. All of them tried other medications, such as buspirone, and without significant effect and underwent POEM.
Discussion: Three patients, 2 male and one female, age 57, 59 and 65 were retrieved. POEM was successfully performed on all those three patients. A short myotomy (average 4 cm) was performed and the average procedure time from scope in to scope out was 33 minutes. The follow up time after POEM was 14 months, 12 months and 1 month respectively. Dysphagia was resolved in all of them. The Echardt score for the first two patients decreased from 7 and 8 to less than 3. They gained 8 pounds and 10 pounds in their recent clinic follow up. The last patient’s Echardt score was also decreased to less than 3, but didn’t report weight gain yet, due to too short time after POEM. Their GERD was unchanged during the follow up period. To our knowledge, this is the first report of short-term outcome of POEM on patients with IEM. For patients with IEM and refractory dysphagia, POEM with short myotomy is effective, though more cases are needed to further confirm the conclusion and long term outcome.
Disclosures:
Hailey Canezaro indicated no relevant financial relationships.
Victoria Andrus indicated no relevant financial relationships.
Elizabeth Armstrong indicated no relevant financial relationships.
David Okuampa indicated no relevant financial relationships.
Lena Kawji indicated no relevant financial relationships.
Michelle Neice indicated no relevant financial relationships.
Maryam Mubashir indicated no relevant financial relationships.
Shazia Rashid indicated no relevant financial relationships.
Syed Musa Raza indicated no relevant financial relationships.
Nazar Hafiz indicated no relevant financial relationships.
Qiang Cai indicated no relevant financial relationships.
Hailey Canezaro, MS1, Victoria Andrus, 1, Elizabeth Armstrong, BA1, David Okuampa, MD1, Lena Kawji, MD2, Michelle Neice, MD1, Maryam Mubashir, MD1, Shazia Rashid, MD1, Syed Musa Raza, MD1, Nazar Hafiz, MD1, Qiang Cai, MD, PhD, MACG1. P3314 - Short Term Outcome of POEM on Patients with Ineffective Esophageal Motility, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
