Andrew N Hanna1, Jashodeep Datta1, Sara Ginzberg2, Kevin Dasher3, Gregory G Ginsberg3, Daniel T Dempsey4. 1. Department of General Surgery, University of Pennsylvania, Philadelphia, PA. 2. University of Pennsylvania School of Medicine, Philadelphia, PA. 3. Department of Internal Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA. 4. Department of General Surgery, University of Pennsylvania, Philadelphia, PA. Electronic address: Daniel.dempsey@uphs.upenn.edu.
Abstract
BACKGROUND: Although laparoscopic Heller myotomy (LHM) has been the standard of care for achalasia, per oral endoscopic myotomy (POEM) has gained popularity as a viable alternative. This retrospective study aimed to compare patient-reported outcomes between LHM and POEM in a consecutive series of achalasia patients with more than 1 year of follow-up. STUDY DESIGN: We reviewed demographic and procedure-related data for patients who underwent either LHM or POEM for achalasia between January 2011 and May 2016. Phone interviews were conducted assessing post-procedure achalasia symptoms via the Eckardt score and achalasia severity questionnaire (ASQ). Demographics, disease factors, and survey results were compared between LHM and POEM patients using univariate analysis. Significant predictors of procedure failure were analyzed using univariate and multivariate analysis. RESULTS: There were no serious complications in 110 consecutive patients who underwent LHM or POEM during the study period, and 96 (87%) patients completed phone surveys. There was a nonsignificant trend toward better patient-reported outcomes with POEM. There were significant differences in patient characteristics including sex, achalasia type, mean residual lower esophageal pressure (rLESP), and follow-up time. The only univariate predictors of an unsatisfactory Eckardt score or ASQ were longer follow-up and lower rLESP, with follow-up length being the only predictor on multivariate analysis. CONCLUSIONS: There were significant demographic and clinical differences in patient selection for POEM vs LHM in our group. Although the 2 procedures have similar patient-reported effectiveness, subjective outcomes seem to decline as a result of time rather than procedure type.
BACKGROUND: Although laparoscopic Heller myotomy (LHM) has been the standard of care for achalasia, per oral endoscopic myotomy (POEM) has gained popularity as a viable alternative. This retrospective study aimed to compare patient-reported outcomes between LHM and POEM in a consecutive series of achalasiapatients with more than 1 year of follow-up. STUDY DESIGN: We reviewed demographic and procedure-related data for patients who underwent either LHM or POEM for achalasia between January 2011 and May 2016. Phone interviews were conducted assessing post-procedure achalasia symptoms via the Eckardt score and achalasia severity questionnaire (ASQ). Demographics, disease factors, and survey results were compared between LHM and POEM patients using univariate analysis. Significant predictors of procedure failure were analyzed using univariate and multivariate analysis. RESULTS: There were no serious complications in 110 consecutive patients who underwent LHM or POEM during the study period, and 96 (87%) patients completed phone surveys. There was a nonsignificant trend toward better patient-reported outcomes with POEM. There were significant differences in patient characteristics including sex, achalasia type, mean residual lower esophageal pressure (rLESP), and follow-up time. The only univariate predictors of an unsatisfactory Eckardt score or ASQ were longer follow-up and lower rLESP, with follow-up length being the only predictor on multivariate analysis. CONCLUSIONS: There were significant demographic and clinical differences in patient selection for POEM vs LHM in our group. Although the 2 procedures have similar patient-reported effectiveness, subjective outcomes seem to decline as a result of time rather than procedure type.
Authors: Grace E Shea; Morgan K Johnson; Manasa Venkatesh; Sally A Jolles; Tyler M Prout; Amber L Shada; Jacob A Greenberg; Anne O Lidor; Luke M Funk Journal: Surg Endosc Date: 2019-07-10 Impact factor: 4.584
Authors: Alexander J Podboy; Joo Ha Hwang; Homero Rivas; Dan Azagury; Mary Hawn; James Lau; Afrin Kamal; Shai Friedland; George Triadafilopoulos; Thomas Zikos; John O Clarke Journal: Surg Endosc Date: 2020-03-10 Impact factor: 4.584
Authors: Eduardo Turiani Hourneaux de Moura; José Jukemura; Igor Braga Ribeiro; Galileu Ferreira Ayala Farias; Aureo Augusto de Almeida Delgado; Lara Meireles Azeredo Coutinho; Diogo Turiani Hourneaux de Moura; Rubens Antonio Aissar Sallum; Ary Nasi; Sergio A Sánchez-Luna; Paulo Sakai; Eduardo Guimarães Hourneaux de Moura Journal: World J Gastroenterol Date: 2022-09-07 Impact factor: 5.374