Rebecca Loh, MD, Alexander Schlachterman, MD
Thomas Jefferson University Hospital, Philadelphia, PA
Introduction: Peroral endoscopic myotomy (POEM) is a relatively new innovate technique that has been shown to be an effective treatment for achalasia. Despite studies demonstrating its effectiveness as a less invasive therapy, POEM is still not as widely implemented as the traditional Heller myotomy for the treatment of achalasia. We aimed to explore the barriers that may impact implementation of POEM and to assess the regional perception of POEM amongst gastroenterologists in an urban setting.
Methods: An Internal Review Board (IRB) approved our 21-question multiple-choice survey that was developed by a panel of specialists that included a POEM trained advanced endoscopist. This was sent via email to 208 physicians practicing in the Philadelphia area. Some questions allowed for responders to select all answers that applied.
Results: Forty-five physicians (45/208, 21.6%) completed our online survey. Of the total 45 responders, 82.2% were male and 68.9% were practicing at an academic medical center. Approximately 73% of responders had treated anywhere from 5 to 50 patients diagnosed with achalasia during their career. Only 11% have treated over 50 patients with achalasia. In assessing what therapies these gastroenterologists have prescribed in the treatment of achalasia, the majority of responders prescribed botulinum toxin injections (86.4%) and endoscopic dilation (standard and pneumatic) (70%). In addition, 72.7% recommended surgical myotomy (laproscopic or open) while only 27.3% prescribed POEM. In fact, 69.8% of responders had never prescribed POEM even though 95.6% would consider POEM for the treatment of achalasia and 78.6% of responders believed POEM will gain acceptance as a main form of therapy. Nearly a quarter (24.4%) of responders were unaware of a program that performed POEM in the area.
Discussion: Although the vast majority of gastroenterologists surveyed considered POEM an acceptable therapy for the treatment of achalasia (95.6%), a significantly smaller portion of physicians had actually recommended it themselves (27.3%). A fairly significant percentage of responders were unaware of a local POEM program, which may have served as a barrier to their implementation of this therapy. Future studies will be to compare our current data to that in 18 months after establishment of a POEM program at a local academic hospital.
Citation: Rebecca Loh, MD, Alexander Schlachterman, MD. P1471 - POEM PERCEPTIONS: A SURVEY OF GASTROENTEROLOGISTS AND THE TREATMENT OF ACHALASIA IN THE PHILADELPHIA REGION. Program No. P1471. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.