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Tu1229 Clinical Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Neoplasms of Patients With Head and Neck Cancer
Abstracts
Tu1229 Clinical Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Neoplasms of Patients With Head and Neck Cancer Joel F. Oliveira*, Ernesto Q. Mendonca, Bruno da Costa Martins, Fabio S. Kawaguti, Marcelo S. de Lima, Sebastian N. Geiger, Caterina Pennacchi, Carla C. Gusmon, Ricardo S. Uemura, Elisa R. Baba, Adriana V. Safatle-Ribeiro, Victor R. Bastos, Renata N. Moura, Luciano Lenz, Gustavo A. de Paulo, Mauricio K. Minata, Mauricio Sorbello, Ulysses Ribeiro, Fauze Maluf-Filho Endoscopic Division, Cancer Institute, University of São Paulo, São Paulo, Brazil Table 1: Clinical outcomes before and after technical proficiency was reached
Tu1228 Sphincter Targeted Endoscopic Therapy for Gerd Demonstrates Obesity Is Not a Factor in Response to Endoluminal Reflux Therapy Mark D. Noar*1,2, Patrick Squires3, Sulman Kahn1 1 The Heartburn and Reflux Study Center, GI Microsurgery Institute, Towson, MD; 2Gastroenterology, Howard County General Hospital Johns Hopkins Medicine, Columbia, MD; 3School of Pharmacy, University of Pittsburgh, Pittsburgh, PA Background: Body mass index (BMI) has been thought to correlate with gastroesophageal reflux disease (GERD) and decreased response to medical and surgical GERD treatments. It is not known if the effect of obesity on reflux is independent of or dependent on the lower esophageal sphincter integrity. Radiofrequency energy delivery (Stretta) to the lower esophageal sphincter (LES) is associated with improvement in the LES resulting in increased LES pressure and decrease in esophageal pH. The aim of this study was to investigate if obesity is a factor in the long-term response to the Stretta procedure and if the integrity of the LES determines the pathogenesis independent of the BMI status. Methods: We prospectively assessed and compared patient reported outcomes in 98 patients comprising three subpopulations of BMI [Normal (18.50 - 24.99), Overweight (25.00 - 29.99), and Obese (30.00)] with refractory GERD before Stretta and throughout ten-years of follow-up. Patient reported outcomes measured were GERD- HRQL (Health Related Quality-of-Life), patient satisfaction scores, and daily medication requirements. Results: Baseline subgroup comparison of lower esophageal sphincter pressure, gastric emptying, and incidence of hiatal hernia and Barrett’s Esophagus also demonstrated no significant differences in association with BMI classification (p>0.05). Median improvement in GERD- HRQL, medication requirements, and satisfaction from baseline to ten-year follow-up was significant (p>0.05) for each BMI group. Improvements noted between groups at 10 years were not significant from one another: GERD HRQL (pZ0.19), satisfaction (pZ0.82) except with regard to medication use (pZ 0.01). Although all subgroups significantly improved from baseline, significant differences were noted between the subgroup comparisons at 10 years (Table I). Conclusions: 1) 10 years following correction of reflux, long term results after Stretta demonstrate effectiveness regardless of the BMI, 2) Obesity or BMI appears to be an independent factor that influences symptoms or response to treatment that is dependent on the integrity of the LES, 3) Improvement to the LES effected by radiofrequency stimulation eliminate the effects of BMI on response to treatment., and 4) This would appear to suggest that the cause of reflux symptoms and response to therapy is more related to LES function and less to BMI as has been previous conjectured.
www.giejournal.org
Background: Surveillance programs of gastrointestinal endoscopy for detection of a second primary cancer in patients with head and neck squamous cell carcinoma (HNSCC) are very important since it can detect synchronous or metachronous esophageal squamous cell carcinoma (ESCC) in up to 15% - 25%. The detection of ESCC in an early phase has paramount importance, since superficial lesions are amenable to endoscopic submucosal dissection (ESD). The aim of this study was to investigate the clinical outcomes of ESD in superficial esophageal neoplasm (SEN) of HNSCC patients in an oncology tertiary center. Methods: From 2010 to 2016, 3280 endoscopies were performed in patients with HNSCC and in 1887 chromoscopy with Lugol and NBI were performed. A total of 26 SENs, submitted to ESD, in 25 patients were retrospectively analyzed. Results: The median tumor size was 4.37 cm (1.83). The en bloc resection rate was 100% and free margin (R0) resection rate was 92.3%. Recurrence occurred in 11.5% (3/26) and one of these patients was successfully treated with endoscopic mucosal resection with snare. Correlation between circumferential extension, number of lesions and stenosis rate are show in table 1. The circumferential resection (100%) was significantly associated with postoperative stricture (Risk Difference Z 66.67% ; CI 95%: 46.51 to 86.83). The average number of endoscopic dilatations for resolution of stenosis was 9.16 (7.62). No procedure-related mortality occurred. Median followup was 11 months. Conclusions: Endoscopic surveillance of HNSCC is very important for detection of SEN. Esophageal ESD of these lesions is feasible and safe with acceptable complication risks despite the high rates of stenosis in circumferential resections.
Table 1. The circumferential extension, number of lesions and stenosis
rate Circumferential Extension 25-49% 50-74% 75-99% 100% 75-100%
Number of lesions 1 (2,56%) 14 (53,84%) 6 (23,07%) 5 (19,23%) 11 (42,30%)
Stenosis Rate 0 (0%) 5 (35,71%) 2 (33,33%) 5 (100%) 7 (63,63%)
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB593
Abstracts
Tu1231 One Year Follow-Up After Poem and Balloon Dilatation for Achalasia - the Results Seem Similar. A Romanian Prospective Survey Marcel Tantau*1,2, Alina Tantau2, Cristian Tefas1,2 1 IRGH Prof. Dr. O. Fodor Cluj-Napoca, Cluj Napoca, Romania; 2 Universitatea de Medicin a si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania
Figure 1: Circumferential esophageal ESD
Tu1230 Short- and Long-Term Outcomes of Endoscopic Submucosal Dissection Using a Scissors-Type Knife for Early Esophageal Neoplasms Yuki Miyasako*, Toshio Kuwai, Yuki Sumida, Takeshi Takasago, Tomoyuki Nishimura, Sumio Iio, Hiroki Imagawa, Toshiki Yamaguchi, Atsushi Yamaguchi, Hirotaka Kouno, Hiroshi Kohno Kure Medical Center and Chugoku Cancer Center, Kure, Japan Purpose: Endoscopic submucosal dissection (ESD) is one of the most useful treatment methods for early esophageal neoplasms. Some conventional devices have been used for ESD, such as insulated-tip, hook, and needle knives. Nevertheless, because these devices are used without fixing to the target, they confer the potential risk of complications due to an unexpected incision. To reduce the risk of complications related to ESD using a conventional knife, we used a scissors-type knife (SB knife: Akita Sumitomo Bakelite) that allowed us to preserve the proper dissecting layer and prevented unexpected muscular layer injury. The aim of our study was to evaluate the efficacy, safety, and clinical outcomes of ESD using a SB knife for early esophageal neoplasms. Methods: We analyzed 100 lesions in73 patients (62 men and 11 women, mean age: 68 years) who underwent esophageal ESD with an SB knife in our hospital between December 2009 and August 2016. We evaluated their clinicopathological characteristics, en bloc resection rate, histological complete resection rate, curative resection rate, tumor size, procedure time, complications, and longterm outcomes, including local recurrence and survival rate. For patients who underwent circumferential or semi-circumferential ESD, prednisolone was administered orally or injected in the base of the ulcer after the ESD to prevent postoperative stricture. Results: The lesion sites consisted of the Ut in 11 patients, the Mt in 53, and the Lt in 36. The histological type was evaluated as squamous cell carcinoma in 96 lesions and adenocarcinoma in 4. The degree of infiltration was assessed as EP/LMP/MM/SM1/SM2 in 15, 31, 13, 2, and 14 patients, respectively. The mean tumor size was 33 mm, and the mean procedure time was 79 minutes. The en bloc, histological complete, and curative resection rates were 100% (100/100), 95% (95/100), and 78% (78/100), respectively. Regarding complications, no delayed hemorrhage or perforation occurred in any of the patients. Pneumonia was observed in 8 patients, and postoperative stenosis in 7. One patient with stenosis required balloon dilatation. In terms of long-term results, the 3- and 5-year overall survival rates were 84.5% and 68.4%, respectively, with a median follow-up of 925 days. In 57 patients for whom curative resection was performed, no local recurrence or distant metastasis were found but metachronal cancer was observed in 8 (14%). In 13 patients for whom noncurative resection was performed, no local recurrence or distant metastasis, relapse, or metachronal cancer was found regardless of the presence or absence of additional treatment. No primary disease-related death occurred. Conclusion: ESD performed using an SB knife can be adequately adopted as not only a technically efficient and safe method but also favorable long-term outcomes for resecting early esophageal neoplasms.
AB594 GASTROINTESTINAL ENDOSCOPY Volume 85, No. 5S : 2017
Introduction: In patients with achalasia, peroral endoscopic myotomy (POEM) is now the proposed method to replace other endoscopic treatments, having a low morbidity and similar or even higher efficacy than its surgical counterpart, the Heller myotomy. However, balloon dilatation is still performed by many. The aim of the present study was to test the effectiveness, the outcome at one year and complications of POEM in consecutive patients with symptomatic achalasia in comparison with pneumatic balloon dilatation. Material and method: All patients who presented with symptomatic achalasia were treated with either pneumatic dilatation or POEM, depending on the age, comorbidities, previous esophageal surgery or patient’s wish. Symptoms were assessed using the Eckardt score (0-12). Endoscopic and radiological assessments were performed in all patients before treatment and at 1 month after treatment. In patients undergoing POEM, a manometry was also carried out before and 1 month after treatment. The patients were regularly contacted for follow-up at 1, 6 and 12 months after treatment. Patients with failure of the initial procedure were treated again, depending on the initial response and the patient’s wish. Results: From November 2013 to May 2015, 60 consecutive patients were treated with either POEM (nZ45) or pneumatic dilatation (nZ15). No patient had previous surgical myotomy in the POEM groups, while 4 patients had previous Heller myotomy in the dilatation group. There were significant improvements in the Eckardt scores of all patients treated, in both the POEM group (before 7.9, after 0.9) and the dilatation group (before 7.4, after 1.8). We recorded 5 incidents in the POEM group, 3 esogastric microperforations, closed safely with endoscopic clips, 1 subcutaneous emphysema, for which temporary cessation of the intervention was necessary, and 3 pneumoperitonea, for which transumbilical decompression using a Veress needle was necessary. We also recorded 2 complications in the form of postprocedural endoscopic clip slippage, which required endoscopic reintervention. No incidents or complications were noted in the dilatation group. All patients treated with POEM were symptom free at 1, 6 and 12 months after treatment. In the dilatation group, 3 patients relapsed at 3 months after treatment, needing additional dilatation. The 8 other patients remained symptom free at 6 and 12 months. There were no statistical significant differences (pZ0.081) with regard to overall treatment failure and outcome at one year between patients treated with POEM and those with balloon dilatation. Conclusions: POEM is an efficacious method for treating achalasia but requires an expert endoscopist with special training. Even in centers where POEM is the standard of care, selected cases could benefit from balloon dilatation, with a similar medium-term efficacy to POEM.
Tu1232 LPR and LPR-GERD Subtypes of Reflux Respond to Sphincter Targeted Endoluminal Gerd Therapy Mark D. Noar*1,2, Patrick Squires3, Sulman Kahn1 1 The Heartburn and Reflux Study Center, GI Microsurgery Institute, Towson, MD; 2Gastroenterology, Howard County General Hospital Johns Hopkins Medicine, Columbia, MD; 3School of Pharmacy, University of Pittsburgh, Pittsburgh, PA Background: Laryngopharyngeal reflux (LPR), is a form of reflux that is poorly understood and not as well studied as typical esophageal reflux. Control of LPR has proven difficult with the usual treatments for gastroesophageal reflux disease (GERD). Reflux may present as various subtypes including typical GERD or esophageal symptoms (SR), pure extra-esophageal (LPR) or a combination of the two (LPR + SR). Until now only Nissen fundoplication has demonstrated consistent success in treating all subtypes of reflux. The aim of this study was to demonstrate the success of long term response in control of various subtypes of reflux, especially LPR, following radiofrequency energy delivery to the lower esophageal sphincter (Stretta) in medically refractory patients with and without LPR. Methods: We prospectively assessed and compared patient reported outcomes in 99 patients comprising three reflux subtypes (LPR, LPR+SR, SR) with refractory GERD before Stretta and throughout ten-years of follow-up. Patient reported outcomes measured were GERD- HRQL (Health Related Quality-of-Life), patient satisfaction scores, and daily medication requirements. Results: Baseline subgroup comparison of lower esophageal sphincter pressure, gastric emptying, incidence of hiatal hernia and BMI also demonstrated no significant differences in association with LPR-GERD classifications (p>0.05). Median improvement in GERD- HRQL, medication requirements, and satisfaction from baseline to ten-year follow-up was significant (p>0.05) for each GERD-LPR group. Improvements noted between groups at 10 years were not significant from one another: GERD HRQL (pZ0.103), medication use (pZ0.273) except with regard to satisfaction (pZ 0.012). Although all subgroups significantly improved from baseline, significant differences were noted between the satisfaction subgroup comparison at 10 years (Table I). Conclusions: 1) Radiofrequency energy delivery to the LES resulted in short and long term control of LPR symptoms,
www.giejournal.org
Tu1229 Clinical Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Neoplasms of Patients With Head and Neck Cancer Joel F. Oliveira*, Ernesto Q. Mendonca, Bruno da Costa Martins, Fabio S. Kawaguti, Marcelo S. de Lima, Sebastian N. Geiger, Caterina Pennacchi, Carla C. Gusmon, Ricardo S. Uemura, Elisa R. Baba, Adriana V. Safatle-Ribeiro, Victor R. Bastos, Renata N. Moura, Luciano Lenz, Gustavo A. de Paulo, Mauricio K. Minata, Mauricio Sorbello, Ulysses Ribeiro, Fauze Maluf-Filho Endoscopic Division, Cancer Institute, University of São Paulo, São Paulo, Brazil Table 1: Clinical outcomes before and after technical proficiency was reached
Tu1228 Sphincter Targeted Endoscopic Therapy for Gerd Demonstrates Obesity Is Not a Factor in Response to Endoluminal Reflux Therapy Mark D. Noar*1,2, Patrick Squires3, Sulman Kahn1 1 The Heartburn and Reflux Study Center, GI Microsurgery Institute, Towson, MD; 2Gastroenterology, Howard County General Hospital Johns Hopkins Medicine, Columbia, MD; 3School of Pharmacy, University of Pittsburgh, Pittsburgh, PA Background: Body mass index (BMI) has been thought to correlate with gastroesophageal reflux disease (GERD) and decreased response to medical and surgical GERD treatments. It is not known if the effect of obesity on reflux is independent of or dependent on the lower esophageal sphincter integrity. Radiofrequency energy delivery (Stretta) to the lower esophageal sphincter (LES) is associated with improvement in the LES resulting in increased LES pressure and decrease in esophageal pH. The aim of this study was to investigate if obesity is a factor in the long-term response to the Stretta procedure and if the integrity of the LES determines the pathogenesis independent of the BMI status. Methods: We prospectively assessed and compared patient reported outcomes in 98 patients comprising three subpopulations of BMI [Normal (18.50 - 24.99), Overweight (25.00 - 29.99), and Obese (30.00)] with refractory GERD before Stretta and throughout ten-years of follow-up. Patient reported outcomes measured were GERD- HRQL (Health Related Quality-of-Life), patient satisfaction scores, and daily medication requirements. Results: Baseline subgroup comparison of lower esophageal sphincter pressure, gastric emptying, and incidence of hiatal hernia and Barrett’s Esophagus also demonstrated no significant differences in association with BMI classification (p>0.05). Median improvement in GERD- HRQL, medication requirements, and satisfaction from baseline to ten-year follow-up was significant (p>0.05) for each BMI group. Improvements noted between groups at 10 years were not significant from one another: GERD HRQL (pZ0.19), satisfaction (pZ0.82) except with regard to medication use (pZ 0.01). Although all subgroups significantly improved from baseline, significant differences were noted between the subgroup comparisons at 10 years (Table I). Conclusions: 1) 10 years following correction of reflux, long term results after Stretta demonstrate effectiveness regardless of the BMI, 2) Obesity or BMI appears to be an independent factor that influences symptoms or response to treatment that is dependent on the integrity of the LES, 3) Improvement to the LES effected by radiofrequency stimulation eliminate the effects of BMI on response to treatment., and 4) This would appear to suggest that the cause of reflux symptoms and response to therapy is more related to LES function and less to BMI as has been previous conjectured.
www.giejournal.org
Background: Surveillance programs of gastrointestinal endoscopy for detection of a second primary cancer in patients with head and neck squamous cell carcinoma (HNSCC) are very important since it can detect synchronous or metachronous esophageal squamous cell carcinoma (ESCC) in up to 15% - 25%. The detection of ESCC in an early phase has paramount importance, since superficial lesions are amenable to endoscopic submucosal dissection (ESD). The aim of this study was to investigate the clinical outcomes of ESD in superficial esophageal neoplasm (SEN) of HNSCC patients in an oncology tertiary center. Methods: From 2010 to 2016, 3280 endoscopies were performed in patients with HNSCC and in 1887 chromoscopy with Lugol and NBI were performed. A total of 26 SENs, submitted to ESD, in 25 patients were retrospectively analyzed. Results: The median tumor size was 4.37 cm (1.83). The en bloc resection rate was 100% and free margin (R0) resection rate was 92.3%. Recurrence occurred in 11.5% (3/26) and one of these patients was successfully treated with endoscopic mucosal resection with snare. Correlation between circumferential extension, number of lesions and stenosis rate are show in table 1. The circumferential resection (100%) was significantly associated with postoperative stricture (Risk Difference Z 66.67% ; CI 95%: 46.51 to 86.83). The average number of endoscopic dilatations for resolution of stenosis was 9.16 (7.62). No procedure-related mortality occurred. Median followup was 11 months. Conclusions: Endoscopic surveillance of HNSCC is very important for detection of SEN. Esophageal ESD of these lesions is feasible and safe with acceptable complication risks despite the high rates of stenosis in circumferential resections.
Table 1. The circumferential extension, number of lesions and stenosis
rate Circumferential Extension 25-49% 50-74% 75-99% 100% 75-100%
Number of lesions 1 (2,56%) 14 (53,84%) 6 (23,07%) 5 (19,23%) 11 (42,30%)
Stenosis Rate 0 (0%) 5 (35,71%) 2 (33,33%) 5 (100%) 7 (63,63%)
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB593
Abstracts
Tu1231 One Year Follow-Up After Poem and Balloon Dilatation for Achalasia - the Results Seem Similar. A Romanian Prospective Survey Marcel Tantau*1,2, Alina Tantau2, Cristian Tefas1,2 1 IRGH Prof. Dr. O. Fodor Cluj-Napoca, Cluj Napoca, Romania; 2 Universitatea de Medicin a si Farmacie Iuliu Hatieganu, Cluj-Napoca, Romania
Figure 1: Circumferential esophageal ESD
Tu1230 Short- and Long-Term Outcomes of Endoscopic Submucosal Dissection Using a Scissors-Type Knife for Early Esophageal Neoplasms Yuki Miyasako*, Toshio Kuwai, Yuki Sumida, Takeshi Takasago, Tomoyuki Nishimura, Sumio Iio, Hiroki Imagawa, Toshiki Yamaguchi, Atsushi Yamaguchi, Hirotaka Kouno, Hiroshi Kohno Kure Medical Center and Chugoku Cancer Center, Kure, Japan Purpose: Endoscopic submucosal dissection (ESD) is one of the most useful treatment methods for early esophageal neoplasms. Some conventional devices have been used for ESD, such as insulated-tip, hook, and needle knives. Nevertheless, because these devices are used without fixing to the target, they confer the potential risk of complications due to an unexpected incision. To reduce the risk of complications related to ESD using a conventional knife, we used a scissors-type knife (SB knife: Akita Sumitomo Bakelite) that allowed us to preserve the proper dissecting layer and prevented unexpected muscular layer injury. The aim of our study was to evaluate the efficacy, safety, and clinical outcomes of ESD using a SB knife for early esophageal neoplasms. Methods: We analyzed 100 lesions in73 patients (62 men and 11 women, mean age: 68 years) who underwent esophageal ESD with an SB knife in our hospital between December 2009 and August 2016. We evaluated their clinicopathological characteristics, en bloc resection rate, histological complete resection rate, curative resection rate, tumor size, procedure time, complications, and longterm outcomes, including local recurrence and survival rate. For patients who underwent circumferential or semi-circumferential ESD, prednisolone was administered orally or injected in the base of the ulcer after the ESD to prevent postoperative stricture. Results: The lesion sites consisted of the Ut in 11 patients, the Mt in 53, and the Lt in 36. The histological type was evaluated as squamous cell carcinoma in 96 lesions and adenocarcinoma in 4. The degree of infiltration was assessed as EP/LMP/MM/SM1/SM2 in 15, 31, 13, 2, and 14 patients, respectively. The mean tumor size was 33 mm, and the mean procedure time was 79 minutes. The en bloc, histological complete, and curative resection rates were 100% (100/100), 95% (95/100), and 78% (78/100), respectively. Regarding complications, no delayed hemorrhage or perforation occurred in any of the patients. Pneumonia was observed in 8 patients, and postoperative stenosis in 7. One patient with stenosis required balloon dilatation. In terms of long-term results, the 3- and 5-year overall survival rates were 84.5% and 68.4%, respectively, with a median follow-up of 925 days. In 57 patients for whom curative resection was performed, no local recurrence or distant metastasis were found but metachronal cancer was observed in 8 (14%). In 13 patients for whom noncurative resection was performed, no local recurrence or distant metastasis, relapse, or metachronal cancer was found regardless of the presence or absence of additional treatment. No primary disease-related death occurred. Conclusion: ESD performed using an SB knife can be adequately adopted as not only a technically efficient and safe method but also favorable long-term outcomes for resecting early esophageal neoplasms.
AB594 GASTROINTESTINAL ENDOSCOPY Volume 85, No. 5S : 2017
Introduction: In patients with achalasia, peroral endoscopic myotomy (POEM) is now the proposed method to replace other endoscopic treatments, having a low morbidity and similar or even higher efficacy than its surgical counterpart, the Heller myotomy. However, balloon dilatation is still performed by many. The aim of the present study was to test the effectiveness, the outcome at one year and complications of POEM in consecutive patients with symptomatic achalasia in comparison with pneumatic balloon dilatation. Material and method: All patients who presented with symptomatic achalasia were treated with either pneumatic dilatation or POEM, depending on the age, comorbidities, previous esophageal surgery or patient’s wish. Symptoms were assessed using the Eckardt score (0-12). Endoscopic and radiological assessments were performed in all patients before treatment and at 1 month after treatment. In patients undergoing POEM, a manometry was also carried out before and 1 month after treatment. The patients were regularly contacted for follow-up at 1, 6 and 12 months after treatment. Patients with failure of the initial procedure were treated again, depending on the initial response and the patient’s wish. Results: From November 2013 to May 2015, 60 consecutive patients were treated with either POEM (nZ45) or pneumatic dilatation (nZ15). No patient had previous surgical myotomy in the POEM groups, while 4 patients had previous Heller myotomy in the dilatation group. There were significant improvements in the Eckardt scores of all patients treated, in both the POEM group (before 7.9, after 0.9) and the dilatation group (before 7.4, after 1.8). We recorded 5 incidents in the POEM group, 3 esogastric microperforations, closed safely with endoscopic clips, 1 subcutaneous emphysema, for which temporary cessation of the intervention was necessary, and 3 pneumoperitonea, for which transumbilical decompression using a Veress needle was necessary. We also recorded 2 complications in the form of postprocedural endoscopic clip slippage, which required endoscopic reintervention. No incidents or complications were noted in the dilatation group. All patients treated with POEM were symptom free at 1, 6 and 12 months after treatment. In the dilatation group, 3 patients relapsed at 3 months after treatment, needing additional dilatation. The 8 other patients remained symptom free at 6 and 12 months. There were no statistical significant differences (pZ0.081) with regard to overall treatment failure and outcome at one year between patients treated with POEM and those with balloon dilatation. Conclusions: POEM is an efficacious method for treating achalasia but requires an expert endoscopist with special training. Even in centers where POEM is the standard of care, selected cases could benefit from balloon dilatation, with a similar medium-term efficacy to POEM.
Tu1232 LPR and LPR-GERD Subtypes of Reflux Respond to Sphincter Targeted Endoluminal Gerd Therapy Mark D. Noar*1,2, Patrick Squires3, Sulman Kahn1 1 The Heartburn and Reflux Study Center, GI Microsurgery Institute, Towson, MD; 2Gastroenterology, Howard County General Hospital Johns Hopkins Medicine, Columbia, MD; 3School of Pharmacy, University of Pittsburgh, Pittsburgh, PA Background: Laryngopharyngeal reflux (LPR), is a form of reflux that is poorly understood and not as well studied as typical esophageal reflux. Control of LPR has proven difficult with the usual treatments for gastroesophageal reflux disease (GERD). Reflux may present as various subtypes including typical GERD or esophageal symptoms (SR), pure extra-esophageal (LPR) or a combination of the two (LPR + SR). Until now only Nissen fundoplication has demonstrated consistent success in treating all subtypes of reflux. The aim of this study was to demonstrate the success of long term response in control of various subtypes of reflux, especially LPR, following radiofrequency energy delivery to the lower esophageal sphincter (Stretta) in medically refractory patients with and without LPR. Methods: We prospectively assessed and compared patient reported outcomes in 99 patients comprising three reflux subtypes (LPR, LPR+SR, SR) with refractory GERD before Stretta and throughout ten-years of follow-up. Patient reported outcomes measured were GERD- HRQL (Health Related Quality-of-Life), patient satisfaction scores, and daily medication requirements. Results: Baseline subgroup comparison of lower esophageal sphincter pressure, gastric emptying, incidence of hiatal hernia and BMI also demonstrated no significant differences in association with LPR-GERD classifications (p>0.05). Median improvement in GERD- HRQL, medication requirements, and satisfaction from baseline to ten-year follow-up was significant (p>0.05) for each GERD-LPR group. Improvements noted between groups at 10 years were not significant from one another: GERD HRQL (pZ0.103), medication use (pZ0.273) except with regard to satisfaction (pZ 0.012). Although all subgroups significantly improved from baseline, significant differences were noted between the satisfaction subgroup comparison at 10 years (Table I). Conclusions: 1) Radiofrequency energy delivery to the LES resulted in short and long term control of LPR symptoms,
www.giejournal.org