Journal of Gastrointestinal Surgery

, Volume 17, Issue 2, pp 228–235

Comparison of Perioperative Outcomes Between Peroral Esophageal Myotomy (POEM) and Laparoscopic Heller Myotomy

  • Eric S. Hungness
  • Ezra N. Teitelbaum
  • Byron F. Santos
  • Fahd O. Arafat
  • John E. Pandolfino
  • Peter J. Kahrilas
  • Nathaniel J. Soper
2012 SSAT Quick Shot Presentation

DOI: 10.1007/s11605-012-2030-3

Cite this article as:
Hungness, E.S., Teitelbaum, E.N., Santos, B.F. et al. J Gastrointest Surg (2013) 17: 228. doi:10.1007/s11605-012-2030-3

Abstract

Background

Peroral esophageal myotomy (POEM) is a novel endoscopic operation for the treatment of achalasia. Few POEM outcome data exist, and no study has compared POEM with the surgical standard, laparoscopic Heller myotomy (LHM).

Methods

Perioperative outcomes were compared between POEM and LHM performed in a nonrandomized fashion. Patients in both groups met the following eligibility criteria: diagnosis of achalasia, age 18–85, and absence of prior achalasia treatment.

Results

Eighteen patients underwent POEM, and 55 patients underwent LHM. Operative times were shorter for POEM (113 vs. 125 min, p < .05), and estimated blood loss was less (≤10 ml in all cases vs. 50 ml, p < .001). Myotomy lengths, complication rates, and length of stay were similar. Pain scores were similar upon post-anesthesia care unit arrival and on postoperative day 1 but were higher at 2 h for POEM patients (3.5 vs. 2, p = .03). Narcotic requirements were similar, although fewer POEM patients received ketorolac. POEM patients’ Eckardt scores decreased (median 1 postop vs. 7 preop, p < .001), and 16 (89 %) patients had a treatment success (score ≤3) at median 6-month follow-up. Six weeks after POEM, routine follow-up manometry and esophagram showed normalization of esophagogastric junction pressures and contrast column heights.

Conclusions

POEM and LHM appear to have similar perioperative outcomes. Further investigation is needed regarding long-term results after POEM.

Keywords

AchalasiaPeroral endoscopic myotomyLaparoscopic Heller myotomyNatural orifice transluminal endoscopic surgery

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  • Eric S. Hungness
    • 1
  • Ezra N. Teitelbaum
    • 1
    • 2
  • Byron F. Santos
    • 1
  • Fahd O. Arafat
    • 1
  • John E. Pandolfino
    • 3
  • Peter J. Kahrilas
    • 3
  • Nathaniel J. Soper
    • 1
  1. 1.Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of SurgeryGeorge Washington UniversityWashington, DCUSA
  3. 3.Division of Gastroenterology and HepatologyNorthwestern University Feinberg School of MedicineChicagoUSA