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

  • 2012 SSAT Quick Shot Presentation
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Journal of Gastrointestinal Surgery Aims and scope

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.

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Acknowledgments

The authors would like to acknowledge Remedios Manuel, R.N., Colleen Krantz, R.N., and Meghan Thompson for their help coordinating the clinical aspects of the study.

Disclosures

Olympus America, Inc. granted instruments used during the POEM procedures, but was not involved in the study design, data collection, analysis, or manuscript preparation. John E. Pandolfino has consulting agreements with Given Imaging and Crospon. Nathaniel J. Soper is on the scientific advisory boards of TransEnterix and Miret Surgical. Eric S. Hungness, Ezra N. Teitelbaum, Byron S. Santos, Fahd O. Arafat, and Peter J. Kahrilas have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 650, Chicago, IL, 60611, USA

    Eric S. Hungness, Ezra N. Teitelbaum, Byron F. Santos, Fahd O. Arafat & Nathaniel J. Soper

  2. Department of Surgery, George Washington University, Washington, DC, USA

    Ezra N. Teitelbaum

  3. Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    John E. Pandolfino & Peter J. Kahrilas

Authors
  1. Eric S. Hungness
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  2. Ezra N. Teitelbaum
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  3. Byron F. Santos
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  4. Fahd O. Arafat
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  5. John E. Pandolfino
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  6. Peter J. Kahrilas
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  7. Nathaniel J. Soper
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Corresponding author

Correspondence to Eric S. Hungness.

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Hungness, E.S., Teitelbaum, E.N., Santos, B.F. et al. Comparison of Perioperative Outcomes Between Peroral Esophageal Myotomy (POEM) and Laparoscopic Heller Myotomy. J Gastrointest Surg 17, 228–235 (2013). https://doi.org/10.1007/s11605-012-2030-3

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  • DOI: https://doi.org/10.1007/s11605-012-2030-3

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