Efficacy and safety of peroral endoscopic myotomy in 100 older patients

• Published in: Esophagus : official journal of the Japan Esophageal Society Vol. 19; no. 2; pp. 324 - 331
• Main Authors: Okada, Hiroki, Shiwaku, Hironari, Ohmiya, Toshihiro, Shiwaku, Akio, Hasegawa, Suguru
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01-04-2022; Springer Nature B.V
• Subjects: Aged; Delirium; Endoscopy; Esophageal Achalasia - etiology; Esophageal Achalasia - surgery; Esophagus; Gastroenterology; Gastrointestinal surgery; Hospitalization; Humans; Medicine; Medicine & Public Health; Middle Aged; Myotomy - adverse effects; Natural Orifice Endoscopic Surgery - adverse effects; Older people; Original Article; Patient safety; Pulmonary aspiration; Retrospective Studies; Side effects; Surgical Oncology; Surgical outcomes; Thoracic Surgery; Treatment Outcome; Aged; Endoscopy; Esophageal achalasia; Safety; Myotomy
• ISSN: 1612-9059; 1612-9067
• DOI: 10.1007/s10388-021-00881-7

Background
Peroral endoscopic myotomy (POEM) is a standard treatment for achalasia. Several reports have described the efficacy and safety of POEM for elderly patients, but none has reported the efficacy and safety of POEM in a large number of elderly patients for > 3 years postoperatively. In this study, we examined the safety and outcome of POEM for 3 years postoperatively in 100 elderly patients.
Methods
One hundred consecutive patients aged > 65 years who underwent POEM from September 2011 to March 2020 were included in this study. In analysis 1, we retrospectively investigated the safety and efficacy of POEM in all patients. In analysis 2, the efficacy and safety of POEM were statistically compared between two groups: the early elderly (65–74 years of age, 55 patients) and late elderly (≥ 75 years of age, 45 patients).
Results
The technical success rate of POEM was 100%. In analysis 1, the 3-month, 1-year, 2-year, and 3-year efficacies of POEM (Eckardt score of ≤ 3) were 100% (92/92 cases), 100% (91/91 cases), 97.8% (88/90 cases), and 100% (92/92 cases), respectively. Procedure-related adverse events occurred in 11% of patients, but none was fatal. Two late elderly patients developed aspiration pneumonia due to delirium and underwent long-term hospitalization. In analysis 2, there were no significant differences in the efficacy and safety of POEM between the two age groups.
Conclusions
POEM is effective and safe for elderly patients. However, precautions are needed regarding the risk of adverse events associated with delirium when POEM is performed in elderly patients.