O17 A PROPENSITY SCORE-MATCHED CASE-CONTROL STUDY TO COMPARE POEM AND LAPAROSCOPIC HELLER MYOTOMY IN THE TREATMENT OF ESOPHAGEAL ACHALASIA

Background We designed this study with the aim of comparing POEM and laparoscopic Heller myotomy+Dor fundoplication (LHD) by matching 2 groups of consecutive patients, treated in 2 high-volume Centers, with the propensity score (PS). Methods Patients undergoing treatment for achalasia from 2014 to 2017 were selected: by applying the PS, 140 patients in both centers were matched. LHD and POEM were performed following established techniques. Patients were followed with clinical, endoscopic and pH-manometry evaluations. Results POEM required a shorter operation time (47 min [35-57]) and postoperative stay (2 days [2-2]) compared to LHD (95 min [85-105] and 3 days [3-3], respectively, p<0.001). No mortality was recorded in either group. Seven complications were recorded in the POEM group (5 mucosal perforations) and 3 in the LHD group (3 mucosal perforations)(p=0.33). At a median follow up of 24 mos. [15-30] for POEM and 31 mos. [15-41] for LHD (p<0.05), the median Eckardt score did not differ: moreover, 99.3% of the POEM patients and 97.7% of the LHD patients showed an Eckardt score ≤ 3 (p <0.12). Four years after the treatment, the probability to be symptom free was > 90% for both groups (98.2% for POEM and 93.9% for LHD, p=0.2, Log-rank test). HR-Manometry showed a similar reduction in the LES pressure and 4sIRP; however, 24-h pH-monitoring showed an abnormal exposure to acid in 38.4% of POEM patients, as compared to 17.1% of LHD patients (p<0.01) and esophagitis was found in 37.4% of the POEM and 15.2% of LHD patients (p<0.05). Finally, the need for PPI therapy was higher in the POEM group (38.8%) compared to the LHD group (15.1%), p<0.001.