S463 Determination of the Association Between Motility Disorders and the Development of Pharyngeal and Esophageal Diverticulum: A Prospective Chart Review

Abstract

Introduction: Numerous studies have shown that per oral endoscopic myotomy (POEM) is a very effective treatment for patients with achalasia. Limited data has also indicated that POEM is effective in treatment for some non-achalasia esophageal motility disorders, such as esophageal-gastric outlet obstruction and diffuse esophageal spasm. We report for the first time the outcome of POEM for patients with atypical chest pain. Methods: Three patients were enrolled: a 72yo female, 87yo male and 73yo female. All patients had a long history of chest pain for at least 5 years. They ranked the pain from 2 to 8 on a 1 to 10 pain scale. The pain was not associated with physical activity, but it was occasionally associated with eating. Only one patient had some dysphagia and no patients reported regurgitation symptoms. All patients were evaluated by multiple doctors over the years, including primary care providers, cardiologists, and gastroenterologists. Cardiac chest pain was ruled out by their cardiologists. They all tried maximal anti-acid therapy, including proton pump inhibitors twice a day for a prolonged period, without any significant improvement. They also tried anti-spasmodic medications, such as hyoscyamine, with limited effect. All patients had esophageal manometry without conclusion. Barium swallow studies showed tertiary contraction and therefore suggested esophageal dysmotility. POEM was discussed with the patients who then provided consent to undergo the procedure (Table ). Results: All three POEMs were successful; the average procedure time was 20 minutes. Only circular muscle myotomy was performed and longitudinal muscle was left intact. Each myotomy was 10 cm in length. There were no postprocedural complications. Postop day 1, all patients were chest pain free and were discharged in the afternoon. Follow up times were 93, 42, and 5 days; pts continued to remain chest pain free. One out of 3 patients described a burning type of chest pain consistent with heartburn and was promptly relieved with anti-acid therapy. Conclusion: From this pilot study, POEM may be a therapeutic modality for patients with refractory atypical chest pain. Further studies with increased sample size and long-term outcome assessments are needed to determine the efficacy of POEM in the treatment of atypical chest pain.