METHODS: Patients undergoing LHM for treatment of achalasia were enrolled in a prospec-tive outcomes database beginning in 2004. Diagnosis was confirmed with high-resolutionmanometry (HRM). Preoperative patient characteristics and perioperative outcomes wererecorded prospectively. To determine current symptoms, we attempted to contact all patientsvia telephone. The Eckardt symptom score and GerdQ surveys were then administered toassess for recurrent achalasia symptoms and iatrogenic GER respectively. Associationsbetween pre and perioperative variables and current symptom scores were tested using abivariate Pearson's correlation. RESULTS: From April, 2004 to August, 2012, 117 patientsunderwent LHM and were enrolled in the database. Of these patients, 67 (57%) weresuccessfully contacted to obtain current symptom scores and were included in the subsequentanalysis. At the time of LHM, patients had a mean age of 55 ±16, symptom duration of 4±5 years, and 43% had prior endoscopic treatment for achalasia. Operative time was 123±21min and EBL was 90 ±55ml. Length of stay 1.1 ±0.4 days. No mortalities or majorcomplications occurred and 10% of patients had a minor (Grade I) complication. The follow-up interval from LHM to current symptom surveys was 4.2 ±2.1 years. Current Eckardtscores were decreased from preoperatively (pre 7.6 ±2.6 vs. current 1.9 ±1.8, scale 0-12,p<.001) and 85% of patients had treatment successes (ie. Eckardt < 4). Currently, 27% ofpatients had symptoms of GER (ie. GerdQ score > 7) and 45% were taking daily anti-refluxmedications. Patients with chest pain preoperatively had higher current Eckardt scores (ie.worse outcomes) (r=.41, p<.001). Operative EBL and periop complications were also posi-tively associated with current Eckardt score (r=.29 and .27, both p<.05). Patients with highercurrent Eckardt scores were more likely to have symptomatic GER (r=.33, p=.01), anassociation that remained significant when the chest pain component of the Eckardt scorewas subtracted from the total. CONCLUSIONS: In this series, LHM was performed safelywith an average hospital stay of one day. At a mean of four years after surgery, 85% ofpatients had relief of achalasia symptoms, but 27% had symptoms of iatrogenic GER. Higheroperative blood loss was associated with worse long-term outcomes. Interestingly, patientswith more severe achalasia symptoms, were also more likely to have symptomatic GER.

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Locally Advanced Esophageal Carcinoma Without Neoadjuvant Therapy: Is ItStill Worth to Operate? a Single Institutional ExperienceMatthias Reeh, Michael F. Nentwich, Asad Kutup, Samir Asani, Maximilian Bockhorn,Guido Sauter, Jakob R. Izbicki, Dean Bogoevski

Objective: To evaluate the impact of upfront surgery without neoadjuvant pre-treatment onsurvival in patients with clinically staged locally advanced esophageal canrcinoma. There isstill controversy about whether neoadjuvant chemo or radio-chemotherapy should be thestandard management in patients with locally advanced esophageal carcinoma. Furthermore,many gastroenterologists and oncologists believe that surgery should be avoided in locallyadvanced esophageal cancer due to high mortality and morbidity rates related to the procedureand the particularly low benefit for the patient. Material and Methods: A retrospectiveanalysis of prospectively collected data of patients with clinically advanced esophageal cancer(cT3) and without neo-adjuvant treatment who underwent thoraco-abdominal esophagec-tomy in curative intent. Locally advanced esophageal cancer was defined based on pre-surgicalcomputertomography, endoscopy and endosonography findings as a tumor infiltrating theparaesophageal tissue or the adjacent structures, with or without lymph node affection.Results: Histological subtypes included 131 squamous-cell carcinomas (SCC) and 81 adeno-carcinomas (AC). Complete resection (R0) was achieved in 84.0% of all 212 patients. Thirty-day mortality rate was 7.1%. Final pathology revealed 50 patients (23.5%) with pT1 or pT2carcinomas which were preoperatively overstaged. Median overall survival following TAEfor SCC was 13.7 months (95% CI; 10.1-17.2 months) and 24.8 months (95% CI; 14.5-35.1 months) for AC, respectively (p= 0.007). The 5-year survival rates were 14% for SCCand 26% for AC, respectively. In median, 27 lymph nodes were resected. On multivariateanalyses, histological type, tumor localization, a lymph node yield higher than 18 resectednodes, tumor grading and resection status remained independent factors influencing overallsurvival Conclusion: Our results in the treatment of patients with locally advanced esophagealcarcinoma undergoing primary TAE are comparable to the results reported for patientsundergoing neoadjuvant chemo-radio-therapy followed by surgery (median 10 to 14 months;5-YOS of 19-23%). Histological subtypes show different survival rates and should thereforebe separately examined in future trials.

Mo1603

The Effect of Oral Sucralfate on the Postprandial Proximal Gastric AcidPocketLuciana C. Silva, Fernando A. Herbella, Marco G. Patti

BACKGROUND: An unbuffered layer of acidity that escapes neutralization by food has beendemonstrated in volunteers and gastroesophageal reflux disease patients, corresponding tothe postprandial proximal gastric acid pocket (PPGAP). It is elusive if this layer of acidityis best conceptualized as a "film" or as a "pocket". Previous studies showed that an alginate-antacid formulation, that forms a raft above the gastric contents, eliminates or displaces thePPGAP. However, there are no studies on the effect of mucosal coating drugs. This studyaims to analyze the effect of oral sucralfate on PPGAP in GERD patients. METHODS:Preliminary results in 10 patients (age 45 (43,5 - 60), 7 females) were studied. All patientsunderwent upper endoscopy to analyze the presence of hiatal hernia, esophagitis or Barrett'sesophagus. Patients underwent a high-resolution manometry for localization of the lowerborder of the lower esophageal sphincter (LBLES). A station pull-through pH monitoringwas performed from 5cm below the LBLES to the LBLES in increments of 1cm in a fastingstate and 10min after a standardized fatty meal and also 10 min after oral administrationof 2g sucralfate. Postprandial proximal gastric acid pocket was defined by the presence ofacid reading (pH<4) in a segment of the proximal stomach between non-acid segmentsdistally (food) and proximally (LBLES). The PPGAP extent and position were comparedbefore and after sucralfate. Standard 24h pH monitoring was performed for objective charac-terization of GERD. The protocol was approved by local ethics committee. Results: Aftersucralfate, PPGAP disappeared in 1 (12%) patient. PPGAP extent increased in 5 (62%) anddiminished in 2 (25%)patients. Two patients (25%) had intraesphincteric PPGAP before

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sucralfate: in 1 of them (12%) the PPGAP moved down LBLES and in the other it disappeared.In 6 (75%) individuals PPGAG remained below the LBLES in both measurements. Aftermeal, PPGAP was not found in two patients and these were excluded from the analysis.CONCLUSIONS: Our results showed that: (1) sucralfate did not show a neutralization effecton the PPGAP, supporting the theory of acid pocket, not acid film, and (2) sucralfate is notan adequate treatment for the PPGAP.

Mo1604

Modified Nissen Fundoplication: Operative Technique and Its Impact onImmediate Postoperative ComplicationsDaniela Diaz Calderon, Rodrigo Y. Adame, Edgar Núñez, Beatriz de Rienzo, Juan F.Molina-Lopez, Cesar Decanini

OBJECTIVE: The pathophysiology and treatment of gastroesophageal reflux disease hasundergone significant changes over the last decade. The aim of this study was to describea modified Nissen fundoplication technique and review the outcomes of a large single-surgeon experience. METHODS: Retrospective review of patients who underwent modifiedNissen fundoplication from 2008 to 2013 by a single surgeon, and comparison of immediatepostoperative results (up to 3 months) with those obtained from a comprehensive reviewof the literature. Patients were evaluated at 1 week, 1 month, and 3 months postoperative.RESULTS: 568 patients (300 men; mean age of 45 [range, 13-76] years) underwent modifiedNissen fundoplication (figure). The median operative time including intraoperative endos-copy was 75 (range, 45-130) minutes. Median length of hospital stay was 2 (range, 2-4)days. No intraoperative complications occurred. Compared to the results obtained from acomprehensive literature review, patients who underwent modified Nissen fundoplicationhad significantly less bloating (P<0.001), persistent postoperative reflux (P=0.01), heartburn(P=0.005), dysphagia (P<0.001), and wrap migration (P<0.001) (table). No significant differ-ences were seen in wrap rotation (P=0.55) or short-term redo fundoplications. Patients whounderwent fundoplication with a 60Fr Savary-Gilliard dilator had significantly less dysphagiacompared to patients in whom a 58Fr dilator was used (4.7% vs. 1%, P=0.018). CONCLU-SION: Modified laparoscopic Nissen fundoplication with intraoperative endoscopy is associ-ated with very low morbidity, and compared to results obtained from a current literaturereview, it results in significantly less immediate postoperative complications.

NS: non-significant.

Mo1605

Racial Disparities in the Characteristics of Surgically Treated AchalasiaPatientsCarla N. Holcomb, Laura A. Graham, Robert Rhyne, Mary T. Hawn

I. Introduction Achalasia is one the most common esophageal motility disorders and Hellermyotomy is the gold standard of surgical treatment. To date, there has been no descriptionof racial disparities in the presentation, treatment, and outcomes of patients with achalasiaundergoing surgical treatment. II.Methods Patients undergoing a laparoscopic Heller myot-omy with or without Dor fundoplication at a single center between the years of 2002-2013were identified using CPT codes. All surgeries were performed by the same surgeon. Aretrospective chart review to abstract data from the electronic medical record was performed.Achalasia classification was based on barium swallow radiographic findings. The independentvariable of interest was race categorized as African American versus Caucasian/Others.Univarate and bivariate frequencies were used to examine differences by race along withChi-square tests for categorical variables and Wilcoxon rank sums for continuous variables.All analyses were performed using SAS version 9.4. III. Results The patient populationconsisted of 287 patients undergoing laparoscopic Heller myotomy for achalasia with African-Americans composing 28% (n=82) of the population. Race was classified as "other" in themedical record of 7.6% (n=22) of the patients and these were included with the Caucasianpopulation in the analysis phase. The African-American patients were more likely to befemale (63.4% vs 44.9% P=0.01), younger (median age 41 vs 50 years, P=<0.001) andreport regurgitation as a preoperative symptom (80.5% vs 60.3% P=<0.001) when comparedto Caucasian/Others. African Americans were more likely to be classified as having Type 1achalasia (81.4% versus 65.5% P=0.03) and to have undergone a previous Heller myotomy(15.9% vs 7.8% P=0.04) at the time of presentation. No significant difference was observedwhen comparing a history of previous esophageal dilatations, overall achalasia recurrence

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