2012 SSAT Quick Shot Presentation

Journal of Gastrointestinal Surgery

, Volume 17, Issue 2, pp 228-235

First online:

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

  • Eric S. HungnessAffiliated withDepartment of Surgery, Northwestern University Feinberg School of Medicine Email author 
  • , Ezra N. TeitelbaumAffiliated withDepartment of Surgery, Northwestern University Feinberg School of MedicineDepartment of Surgery, George Washington University
  • , Byron F. SantosAffiliated withDepartment of Surgery, Northwestern University Feinberg School of Medicine
  • , Fahd O. ArafatAffiliated withDepartment of Surgery, Northwestern University Feinberg School of Medicine
  • , John E. PandolfinoAffiliated withDivision of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine
  • , Peter J. KahrilasAffiliated withDivision of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine
  • , Nathaniel J. SoperAffiliated withDepartment of Surgery, Northwestern University Feinberg School of Medicine

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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

Achalasia Peroral endoscopic myotomy Laparoscopic Heller myotomy Natural orifice transluminal endoscopic surgery