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LONG-TERM DYSPHAGIA RESOLUTION FOLLOWING POEM VERSUS LHM IN PATIENTS WITH ACHALASIA

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

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