Comparison of the long-term health-related quality of life between peroral endoscopic myotomy and laparoscopic Heller myotomy for achalasia

Mingtian Wei, MD, Hang Yi, MD, Zongguan Zhou, MD, Bing Hu, MD, Ziqiang Wang, MD. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University.

Background: Peroral endoscopic myotomy (POEM), as a novel less invasive technique, has been proved effective and safe in the treatment of achalasia, when compared to standard laparoscopic Heller myotomy (LHM). The existing literatures mainly pay attentions to the clinical measures, such as symptoms, physical outcomes. There is no comparison of two surgical procedures on health-related quality of life, especially achalasia-specific health-related quality of life (achalasia-DSQoL) in the long-term follow up. Thus, the purpose of this study is to compare the health-related quality of life between POEM and LHM, performed by an Asian surgical practice.

Methods: We retrospectively reviewed consecutive achalasia patients who underwent POEM and LHM between December 2010 and January 2013 in our institution. All the patients were followed at mean 11.7 and 20.2 months after surgery by using SF-36 and achalasia-DSQoL questionnaires, respectively. Gastroesophageal reflux disease-health related quality of life (GERD-HRQL) questionnaire was investigated in the first follow-up. And Eckardt score was recorded in the second follow-up. In addition, symptom improvements in the two follow-ups were assessed. All data analyses were conducted by software SPSS, with corresponding statistical testing method.

Results: Overall, 23 consecutive achalasia patients (10 in POEM, 13 in LHM) were enrolled in the study. Both groups were comparable on sex, BMI, ASA, symptoms duration, and prior therapies. Mean operation time and median postoperative hospital stay were 85.0 min., 78.8 min. (P=0.59) and 4.5 days, 7 days (P =0.02). Postoperative complications occurred in 20% in POEM and 15.4% in LHM. All eight domains of SF-36 in the first follow-up between two groups were adjacent with no significant difference. However, statistical lower GERD-HRQL score was observed in LHM with a mean 1.5±1.5 compared to a mean 3.8±2.4 in POEM (P=0.02). Achalasia-DSQoL scores between two groups were equivalent (14.9±2.6 vs. 13.5±2.3, P=0.19). Low Eckardt scores of 1.5±0.7 in POEM and 1.3±0.9 in LHM were estimated (P=0.61). LHM provided better dysphagia relief of 2.3±0.48 score in the first follow-up, which was significantly lower than 1.54±0.52 in POEM (P=0.004). However, there were no significant differences on heartburn and swallowing pain between two groups, were no statistical differences on improvement of each symptom in two follows.

Conclusion: In our practice, POEM achieves both equivalent long-term SF-36 and achalasia-DSQoL assessments compared with laparoscopic Heller myotomy for achalasia, although higher gastroesophageal reflux and dysphagia rates were found in the follow-up.

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