48: LAPAROSCOPIC HELLER DOR IS AN EFFECTIVE TREATMENT FOR ESOPHAGEAL-GASTRIC JUNCTION OUTFLOW OBSTRUCTION

Abstract Background and aim Esophago-gastric junction outflow obstruction (EGJOO) is a relatively new clinical entity revealed by high-resolution manometry (HRM) that can have two different etiologies, i.e. idiopathic or secondary (esophageal strictures, eosinophilic esophagitis, giant hiatal hernia, prior fundoplication bariatric surgery, malignancy). Treatment of EGJOO currently mirrors achalasia, but this based only on few studies with small case series. The study was to assess the outcome laparoscopic Heller-Dor (LHD) in patients EGJOO, as compared esophageal achalasia. Methods Between 2016–2019, all diagnosis referred our Centre for dysphagia food regurgitation were prospectively collected. Naïve first given medical treatment Ca2+ channel blockers 6 months. Then ‘restaged’: without improvement and/or whose integrated relaxation pressure (IRP) had not decreased scheduled LHD. who already been treated elsewhere botox injections, pneumatic dilations upfront Patients underwent LHD radiological stage I achalasia group further analyzed subgrouping manometric-pattern. failure defined persistence reoccurrence Eckardt score > 3 need retreatment. Results During period, 150 enrolled: 25 125 (25 pattern I, 74 II, 26 III). median follow-up 24 months (IQR: 34–16). successful 96% 98.7% those 96.2% III (P = 0.50). Six-month post-operative HRM showed reduction LES resting IRP 4 groups < 0.001). Conclusion This comparative prospective data collection EGJOO. emerged an effective excellent success rate, comparable procedure’s efficacy treating early-stage