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

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 

References

  1. 1.
    Francis DL, Katzka DA. Achalasia: update on the disease and its treatment. Gastroenterology 2010;139:369–74.PubMedCrossRefGoogle Scholar
  2. 2.
    Boeckxstaens GE, Annese V, des Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. The New England journal of medicine 2011;364:1807–16.PubMedCrossRefGoogle Scholar
  3. 3.
    Patti MG, Pellegrini CA. Esophageal achalasia 2011: pneumatic dilatation or laparoscopic myotomy? Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2012;16:870–3.CrossRefGoogle Scholar
  4. 4.
    Kostic S, Kjellin A, Ruth M, et al. Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. Results of a randomized controlled trial. World journal of surgery 2007;31:470–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Annals of surgery 2009;249:45–57.PubMedCrossRefGoogle Scholar
  6. 6.
    Rattner D, Kalloo A, Group ASW. ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005. Surgical endoscopy 2006;20:329–33.PubMedCrossRefGoogle Scholar
  7. 7.
    Othman MO, Wallace MB. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in 2011, a Western perspective. Clinics and research in hepatology and gastroenterology 2011;35:288–94.PubMedCrossRefGoogle Scholar
  8. 8.
    Pasricha PJ, Hawari R, Ahmed I, et al. Submucosal endoscopic esophageal myotomy: a novel experimental approach for the treatment of achalasia. Endoscopy 2007;39:761–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010;42:265–71.PubMedCrossRefGoogle Scholar
  10. 10.
    von Renteln D, Inoue H, Minami H, et al. Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. The American journal of gastroenterology 2012;107:411–7.CrossRefGoogle Scholar
  11. 11.
    Swanstrom LL, Rieder E, Dunst CM. A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders. Journal of the American College of Surgeons 2011;213:751–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Costamagna G, Marchese M, Familiari P, Tringali A, Inoue H, Perri V. Peroral endoscopic myotomy (POEM) for oesophageal achalasia: Preliminary results in humans. Digestive and Liver Disease 2012;44(10):827-32.Google Scholar
  13. 13.
    Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 2008;135:1526–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Bredenoord AJ, Fox M, Kahrilas PJ, et al. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society 2012;24 Suppl 1:57–65.CrossRefGoogle Scholar
  15. 15.
    Eckardt VF. Clinical presentations and complications of achalasia. Gastrointestinal Endoscopy Clinics of North America 2001; 11: 281–92, vi.Google Scholar
  16. 16.
    Vaziri K, Soper NJ. Laparoscopic Heller myotomy: technical aspects and operative pitfalls. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2008;12:1586–91.CrossRefGoogle Scholar
  17. 17.
    Jones R, Junghard O, Dent J, et al. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Alimentary pharmacology & therapeutics 2009;30:1030–8.CrossRefGoogle Scholar
  18. 18.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery 2004;240:205–13.PubMedCrossRefGoogle Scholar
  19. 19.
    Ren Z, Zhong Y, Zhou P, et al. Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surgical Endoscopy 2012. doi:10.1007/s00464-012-2336-y
  20. 20.
    Rawlings A, Soper NJ, Oelschlager B, et al. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surgical endoscopy 2012;26:18–26.PubMedCrossRefGoogle Scholar
  21. 21.
    Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Annals of surgery 2008;248:1023–30.PubMedCrossRefGoogle Scholar
  22. 22.
    Novais PA, Lemme EM. 24-h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy. Alimentary pharmacology & therapeutics 2010;32:1257–65.CrossRefGoogle Scholar

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

Personalised recommendations