Grace E Shea, BA, Kevin D Davies, MS, Manasa Venkatesh, MA, MS, Sally Jolles, MA, Tyler M Prout, MD, Amber Shada, MD, Jacob A Greenberg, MD, EdM, Anne O Lidor, MD, MPH, Luke M Funk, MD, MPH. University of Wisconsin Hospital and Clinics, Madison, WI
Introduction: The objective of this study was to evaluate patient-reported outcomes for achalasia patients who underwent either peroral endoscopic myotomy (POEM) or laparoscopic Heller myotomy (LHM) and had at least one year of follow-up. LHM has historically been considered the gold standard treatment for achalasia. However, POEM is a less invasive procedure and offers a quicker recovery. Although some studies have compared short-term outcomes of LHM to POEM, the strongest predictors of long-term dysphagia resolution are unclear.
Methods and Procedures: Data from our single academic institutional foregut database were used to identify achalasia patients who underwent LHM or POEM over a 9-year period. Postoperative outcomes were assessed via telephone for patients with at least one year of follow-up using Eckardt dysphagia scores. Electronic health record data were reviewed to extract patient characteristics and operative data. Patient age, sex, type of operation, and length of follow-up were included in a multivariable linear regression model with Eckardt score as the outcome.
Results: Our cohort included 125 patients (93 LHM and 32 POEM). Sixty-four patients completed a phone survey at the one year or greater time interval (response rate=51%). Mean Eckardt scores were 2.95 and 1.85 at a median follow-up of 48 and 12 months for LHM and POEM patients, respectively (an Eckhardt score ≤ 3 is considered successful). On multivariable analysis, operative approach was not associated with a statistically significant difference in dysphagia outcomes.
Conclusions: POEM and LHM were associated with similar rates of dysphagia resolution at a median of 3 years of follow-up. Both procedures should be considered durable treatment options for achalasia.
Table 1. Bivariate and Multivariate Predictors of Postoperative Dysphagia
| Variable | Bivariate Analysis* | Multivariate Analysis* | |
| β-coeff (p-value) | β-coeff (p-value) | ||
| Sex (N,%) | 0.14(0.81) | -0.20(0.74) | |
| Male | 36(56.3) | ||
| Female | 28(43.8) | ||
| Age (mean, SD) | 56.2(16.9) | 0.01(0.65) | 0.01(0.48) |
| Procedure Type (N,%) | 1.10(0.07) | 1.21(0.09) | |
| POEM | 21(32.8) | ||
| LHM | 43(67.2) | ||
| Follow-up interval (months) | 29.5 | 0.01(0.54) | 0.0001(0.99) |
| POEM | 12 | ||
| LHM | 48 |
*The reference group consisted of male sex and POEM as an operative approach.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92873
Program Number: P461
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster