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Establishment of a per oral endoscopic myotomy program at a rural tertiary care center

  • 2020 SAGES Poster
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Abstract

Background

This study’s purpose is to determine the application and effectiveness of a POEM program in the rural healthcare setting. Achalasia has a substantial impact on the lives of afflicted patients. Traditionally, a Heller myotomy with fundoplication has been the standard of care for treatment. In 2008, the first per oral endoscopic myotomy (POEM) was performed in Japan. Since 2017, our rural healthcare institution has performed approximately 60 POEMs.

Methods

An IRB approved, single-institution retrospective review of patient outcomes after POEM was performed along with prospective analysis of post-operative surveys. An institutional cost analysis was also performed. Demographic and qualitative variables were measured and included PPI use, a Likert scale of 0–5 for progressively worsening symptoms of heartburn, dysphagia, and regurgitation. In addition, we included a Dysphagia Outcome and Severity Scale.

Results

The number of myotomy operations increased from 4.5 per year to 28.8 per year after initiation of the POEM program. Mean Likert scale scores were 0.91, 0.73, and 1 for heartburn, dysphagia, and regurgitation, respectively. 72.5% percent of patients were satisfied with their present condition. 87.5% of patients reported minimal or no dysphagia on the Dysphagia Severity Scale. Intraoperative costs were $2477 for laparoscopic myotomy and $1650 for POEM. The capital expense of the equipment required to perform POEM was $110,232. Average contribution margin per case was $6024. The procedure pays off capital outlay upon completion of the 19th case.

Conclusions

This study shows that patients have excellent symptom control after POEM. When compared to the institution’s laparoscopic myotomy volume, POEM far surpasses in terms of operative volume and monetary benefit. Examination of these data shows that a rural hospital can successfully employ a state-of-the-art intervention when there is a population in need and an infrastructure in place.

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Authors and Affiliations

  1. Division of Thoracic and Foregut Surgery, Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, 115 Heart Drive #3103, Greenville, NC, 27834, USA

    Austin Rogers, Carlos Anciano, Robert Allman, Dante Dali, Aundrea Oliver, Mark Iannettoni & James Speicher

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  1. Austin Rogers
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  2. Carlos Anciano
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  3. Robert Allman
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  4. Dante Dali
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  5. Aundrea Oliver
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  7. James Speicher
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Correspondence to James Speicher.

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Disclosures

Dr. Anciano has a relationship with Johnson & Johnson as a Clinical Consultant/Preceptor evaluating and supervising the placement of an anti-reflux device, with no relation pertaining to this manuscript. Drs. Rogers, Allman, Dali, Oliver, Iannettoni, and Speicher have no conflicts of interest or financial ties to disclose.

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Rogers, A., Anciano, C., Allman, R. et al. Establishment of a per oral endoscopic myotomy program at a rural tertiary care center. Surg Endosc 35, 3981–3988 (2021). https://doi.org/10.1007/s00464-020-07775-2

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