P2416 - Outcomes of Esophagectomy in End-Stage Achalasia: A Nationwide Population-Based Study

Abdul Mohammed, MD¹, Ahmed Eltelbany, MD, MPH², Alexander Wu, ³, Sara Ghoneim, MD¹, Neethi Paranji, MD¹, Nisheet Waghray, MD^1
1MetroHealth Medical Center, Cleveland, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³Northeast Ohio Medical University, Rootstown, OH

Introduction: Esophagectomy is an effective treatment for end-stage achalasia but is associated with significant postoperative complications. There is a paucity of data regarding the impact of a prior intervention on subsequent esophagectomy in the treatment of advanced achalasia. Our aim is to understand esophagectomy outcomes in end-stage achalasia with and without prior pneumatic dilation (PD) or myotomy.

Methods: We performed a retrospective analysis using the IBM Explorys database (1999-2020), a pooled, de-identified clinical database of over 63 million unique patients in the USA. Outcomes were compared between advanced achalasia patients who underwent esophagectomy with and without prior PD or myotomy. Further, subgroup analysis was performed on outcomes between patients who had undergone prior PD versus myotomy.

Results: A total of 800 patients underwent esophagectomy for advanced achalasia. There were no significant differences in the baseline characteristics and rates of outcomes between the presence or absence of prior intervention. Based on the type of previous intervention, the cohort was further divided into two groups: prior history of PD or prior history of myotomy. Patients with a history of PD before esophagectomy had higher odds of acute myocardial infarction, congestive heart failure, cerebrovascular disease, malnutrition. On the contrary, patients with a history of myotomy had higher odds of chronic renal impairment. In addition, Caucasians were more likely to undergo pneumatic dilation, while African-Americans underwent myotomy more often before esophagectomy. Finally, patients undergoing myotomy before esophagectomy were more likely to be female. (Table 1)

Discussion: In our study of patients with advanced achalasia, prior PD or esophagomyotomy did not worsen the peri-operative outcomes of esophagectomy. Therefore, regardless of prior intervention, surgical referral for advanced achalasia appears safe. There were also no significant differences in baseline characteristics based on the presence or absence of prior intervention. However, when compared to the type of prior intervention, patients who underwent myotomy before esophagectomy were more likely to have chronic renal impairment, while atherosclerotic vascular disease is more commonly associated with PD.



Disclosures:


Abdul Mohammed, MD¹, Ahmed Eltelbany, MD, MPH², Alexander Wu, ³, Sara Ghoneim, MD¹, Neethi Paranji, MD¹, Nisheet Waghray, MD¹. P2416 - Outcomes of Esophagectomy in End-Stage Achalasia: A Nationwide Population-Based Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.