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Clinical and financial outcomes of per-oral endoscopic myotomy compared to laparoscopic heller myotomy for treatment of achalasia

  • 2022 SAGES Oral
  • Published:
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Abstract

Background

Previous studies analyzing short-term outcomes for per-oral endoscopic myotomy (POEM) have shown excellent clinical response rates and shorter operative times compared to laparoscopic Heller myotomy (LHM). Despite this, many payors have been slow to recognize POEM as a valid treatment option. Furthermore, comparative studies analyzing long-term outcomes are limited. This study compares perioperative and long-term outcomes, cost-effectiveness, and reimbursement for POEM and LHM at a single institution.

Methods

Adult patients who underwent POEM or LHM between 2014 and 2021 and had complete preoperative data with at least one complete follow up, were retrospectively analyzed. Demographic data, success rate, operative time, myotomy length, length of stay, pre- and postoperative symptom scores, anti-reflux medication use, cost and reimbursement were compared.

Results

58 patients met inclusion with 25 undergoing LHM and 33 undergoing POEM. There were no significant differences in preoperative characteristics. Treatment success (Eckardt ≤ 3) for POEM and LHM was achieved by 88% and 76% of patients, respectively (p = 0.302). POEM patients had a shorter median operative time (106 min. vs. 145 min., p = 0.003) and longer median myotomy length (11 cm vs. 8 cm, p < 0.001). All LHM patients had a length of stay (LOS) ≥ 1 day vs. 51.5% for POEM patients (p < 0.001). Both groups showed improvements in dysphagia, heartburn, regurgitation, Eckardt score, GERD HRQL, RSI, and anti-reflux medication use. The improvement in dysphagia score was greater in patients undergoing POEM (2.30 vs 1.12, p = 0.003). Median hospital reimbursement was dramatically less for POEM ($3,658 vs. $14,152, p = 0.002), despite median hospital costs being significantly lower compared to LHM ($2,420 vs. $3,132, p = 0.029).

Results

POEM is associated with a shorter operative time and LOS, longer myotomy length, and greater resolution of dysphagia compared to LHM. POEM costs are significantly less than LHM but is poorly reimbursed.

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Authors and Affiliations

  1. Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA, 18510, USA

    Lena Shally

  2. Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA

    Kashif Saeed, Derek Berglund, Mark Dudash, Vladan N. Obradovic, Anthony T. Petrick, Jon D. Gabrielsen & David M. Parker

  3. Department of Population Health and Sciences, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA

    Katie Frank

  4. Department of Gastroenterology and Nutrition, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA

    David L. Diehl

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Lena Shally, Katie Frank, and Drs. Kashif Saeed, Derek Berglund, Mark Dudash, Vladan N Obradovic, David M Parker, Anthony T Petrick, David L Diehl and Jon D Gabrielsen have no conflicts of interest or financial ties to disclose.

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Supplemental Figure 1. POEM operative times since the procedure was first performed in June 2015 (n = 72). Pearson’s correlation coefficient r and associated p-value given in top right corner. Observed values (black points) are overlaid on top of the line of best fit (blue) and its estimated 95% confidence interval (shaded gray band).

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Shally, L., Saeed, K., Berglund, D. et al. Clinical and financial outcomes of per-oral endoscopic myotomy compared to laparoscopic heller myotomy for treatment of achalasia. Surg Endosc 37, 5526–5537 (2023). https://doi.org/10.1007/s00464-022-09652-6

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