wide range of endoscopic findings, including plaques, exudates, strictures, linearfurrows, rings, and ulcerations. Little is known about whether specific endoscopicfindings correlate with clinical symptoms. Food impaction is a common complicationof EoE and can be associated with significant comorbidities. Identifying specificendoscopic findings on diagnosis that may predispose to development of foodimpaction can help better understand the mechanisms by which EoE leads tosymptoms and allow more targeted therapy. Aims: To identify specific mucosalfindings on upper endoscopy (EGD) at the time of initial EoE diagnosis thatcorrelate with a clinical history of food impactions. Methods: This was aretrospective cohort study of patients diagnosed with esophageal eosinophilia onmucosal biopsies from EGD at a tertiary care center in 6/2005-8/2012. Patients withfood impaction episodes prior to endoscopic diagnoses or �15 eosinophils on highpowered field from esophageal biopsies were excluded. Demographic data, co-morbidities, clinical symptoms, endoscopic findings on initial EGD, and history offood impaction were obtained from patient records. Fisher-exact or chi-sqaured testwas used for univariate analysis. Multivariate analysis was performed using forwardstepwise logistic regression. Results: 300 patients (mean age 42�14, 39%F) metinclusion criteria. 50 (16%) subjects had a history of a food impaction. On univariateanalysis, the endoscopic finding of rings and furrows was significantly associatedwith a history of food impactions (OR�1.8, p�0.04). No association with foodimpaction was found with stricture, ulcer, esophageal narrowing, tears, erosions,exudates, hernias, or plaques. On multivariate analysis, endoscopic findings of ringsand furrows remained independently associated with food impaction (OR�1.8, p�.04). Conclusions: The endoscopic finding of rings and furrows on diagnosis isindependently associated with a history of food impaction in patients with EoE.Strictures, esophageal narrowing, plaques, and erosions were not found to beassociated with food impaction. This suggests that abnormal mucosa and dysmotilitymay play a bigger role in the mechanism of food impaction in EoE patients thanchronic inflammation and fibrosis-induced mechanical obstruction. Further studiesare needed to further delineate the pathophysiology and underlying mechanism ofEoE-related symptoms.

Su1509High Resolution Manometry Is Comparable to Timed BariumEsophagogram for Assessing Response to Pneumatic Dilation inPatients With Achalasia CardiaUday C. Ghoshal*1, Mahesh Gupta1, Abhai Verma1, Samir Mohindra1,Zafar Neyaz2, Asha Misra1, Vivek A. Saraswat11Dept. of Gastroenterology, Sanjay Gandhi Postgraduate Institute ofMedical Sciences, Lucknow, India; 2Dept. of Radiology, Sanjay GandhiPostgraduate Institute of Medical Sciences, Lucknow, IndiaBackground: Reduction in height of barium column in timed barium esophagogram(TBE) and lower esophageal sphincter (LES) pressure on manometry have beenused to assess efficacy of pneumatic dilation (PD) in patients with achalasia.However, there is hardly any data comparing these two methods to assess efficacyof PD. Methods: 62 patients with achalasia undergoing PD were evaluated clinically(using Eckardt score), high resolution manometry (HRM) and TBE (films taken at 1and 5 minutes) before and four weeks after PD, which was done using 30 mm and35 mm Rigiflex balloon (Microvasive, Milliford, MA, USA) in female and malepatients, respectively. Response was defined clinically as Eckardt score � 2, bymanometry as LES pressure less than 22.5 mmHg and by TBE as adequateesophageal emptying (reduction in height of barium column by more than 50% ofpre-treatment value in five minute radiograph). Results: 43 of 62 (69%) patients [age34�12-y, 36 (58%) male) responded and 19 (31%) did not respond to first session ofPD as assessed by post-PD Eckardt score. 38/43 (88%) responders had adequateesophageal emptying of barium in TBE while 31/43 (72%) had LES pressure below22.5 mmHg on HRM (p�ns). 8/19 (42%) non-responders showed failure inesophageal emptying (defined by lack of reduction in height of barium column by50%) in TBE and 11/19 (58%) had LES pressure �22.5 mmHg (p�ns). Conclusion:TBE and esophageal HRM were comparable in assessing efficacy of PD in treatmentof achalasia.

Su1510PerOral Endoscopic Myotomy (POEM) for Achalasia: Pilot CaseSeries of a Western Referral CenterJean Pierre Charton*, Brigitte Schumacher, Thomas Toermer,Horst NeuhausGastroenterology, EVK Duesseldorf, Duesseldorf, GermanyBackground: Esophageal achalasia is a motoric disorder that is characterized byabsence of propulsive peristalsis of the distal esophagus and incomplete relaxationof the lower esophageal sphincter (LES). Balloon dilatation or laparoscopic Hellersmyotomy seem to be equally effective therapeutic options. Recently, POEM wasintroduced as a minimally invasive alternative therapy but has so far been evaluatedin only a few clinical trials in highly specialized centers. Aim & Methods: The aimwas to evaluate the feasibility, safety and outcome of POEM. Consecutive patientswith achalasia were included after confirmation of the diagnosis according tosymptoms with determination of the Eckardt symptom score, EGD, esophagogram

and high-resolution manometry (HRM). POEM was performed under generalanesthesia by two endoscopists with extensive experience in interventionalendoscopy. The technique was used as previously described (1): 1. esophagealmucosal incision, 2. submucosal tunneling of the esophagus to the lesser curvatureof the cardia, 3. myotomy of (at least) the circular esophageal muscle bundle and 4.closure of the esophageal incision with endoscopic clips. During follow-up, theindex examinations were repeated. Results: Over a period of 20 months, 21 patients(11 m, 10 f, 19-76 years) with confirmed achalasia were treated with POEM. 12 ofthese cases had been treated previously by balloon dilatation and/or botox injection.The mean length of myotomy was 12cm (range 5-22cm). All POEM procedures wereprimarily successful. There was no major complication and only 4 minorcomplications. In one patient, a longer tear of the submucosal tunnel on themucosal site could be closed with clips. In another case, a pneumomediastinum wasmanaged conservatively. So far, 18 patients have been followed over at least 3months (mean 9 months). All patients reported symptomatic improvement orfreedom of symptoms with a decrease of the Eckardt score from a mean of 6.62 to amean of 1.39 (p�0.001) and a decrease of the LES pressure from 46mmHg to22mmHg (p�0.003). Only one patient with vigorous achalasia reported progressivedysphagia due to recurrence of hypertensive contractions in midesophagus.5/16patients (31%) with a follow-up of at least 3 months reported new occurrence ofreflux symptoms. Conclusion: POEM is a new, minimally-invasive treatment forsymptomatic esophageal achalasia even after failure of balloon dilation. Short-termresults are very promising with significant relief of symptoms and decrease of theLES pressure in all cases. Comparative clinical trials and long-term results areneeded, particularly under consideration of the development of reflux disease.

Su1511Patients Over the Age of 40, Diagnosed With Type 1 Achalasiaby Chicago Classification, Show the Best Indication forPneumatic DilatationYuriko Tanaka*1, Katsuhiko Iwakiri2,1, Noriyuki Kawami1,Hirohito Sano1, Choitsu Sakamoto1

1Nippon Medical School, Tokyo, Japan; 2Nippon Medical School ChibaHokusoh Hospital, Inzai, JapanBackground: It has been reported that one factor predicting a better outcome ofpneumatic dilatation (PD), is in over 40 year old patients with achalasia. A recentclassification of achalasia, (the Chicago classification), classifies achalasia into 3subtypes when using high-resolution manometry (HRM), however the treatmentoutcome of PD for the 3 subtypes, is not clear. The aim of this study is to investigatethe treatment response to PD for the 3 subtypes of achalasia, including the agefactor. Methods: Between January, 2002 and June, 2011, 73 consecutive patientswith achalasia (36 male, 37 female, mean age 51.7 years), diagnosed by HRM, weretreated with PD and success from PD is defined as clinical remission of more than 6months. Patients with achalasia were classified into subtypes as follows - Type 1:where there was no distal esophageal pressurization to �30 mmHg in �8 after 10test swallows, Type 2: at least 2 test swallows were associated with panesophagealpressurization to greater than 30 mmHg, Type 3: patients had 2 or more spasticcontractions with or without a period of compartmentalized pressurization accordingto the Chicago classification. Firstly, the relationship between the subtypes ofachalasia and the treatment outcome from PD was investigated. Next, each subtypewas classified into 2 groups (under or over 40 years of age) and the treatmentoutcome from PD in each group was investigated. Results: Patients with Type 1 hadthe best response (88.2%, 30/34) compared with Type 2 (58.8%, 20/34) and Type 3(60.0%, 3/5). The response rate to PD in patients with Type 1 was significantly(p�0.006) greater than in patients with Type 2. The shows the results of theresponse rate to PD of the 3 subtypes, including the age factor. Conclusions: Inpredicting the outcome of PD, it is useful to use the subtypes of achalasia asoutlined in the Chicago classification and furthermore, by including the agefactor, the outcome from PD can be predicted more accurately. Patients, over 40years of age, with Type 1 achalasia show the best indication for PD.

Su1512PerOral Endoscopic Myotomy (POEM) for Esophageal Achalasia.Oucomes of the First 52 Patients With Mid-Term Follow-upPietro Familiari*1, Michele Marchese1, Margareth Martino2,Roberta Rea2, Ivo Boskoski1, Francesca Picconi2, Andrea Tringali1,Vincenzo Bove1, Alessandra Bizzotto1, Clelia Marmo1, Vincenzo Perri1,Guido Costamagna1

1Digestive Endoscopy Unit, Universita’ Cattolica del Sacro Cuore,Rome, Italy; 2Digestive Endoscopy, Campus-Biomedico University,Rome, ItalyBackground: Peroral Endoscopic Myotomy (POEM) is a new technique for thetreatment of esophageal achalasia. POEM combines the benefits of Heller’sprocedure with the advantages of a less invasive, scarless, endoscopic intervention.Aim of this study is to present the outcomes of POEM, in a large series of patients,with a mid-term follow-up. Methods: Fifty-two patients (19 men, mean age 45 years

Abstracts

www.giejournal.org Volume 77, No. 5S : 2013 GASTROINTESTINAL ENDOSCOPY AB351