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Long-term dysphagia resolution following POEM versus Heller myotomy for achalasia patients

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Abstract

Background

Heller myotomy (HM) has historically been considered the gold standard treatment for achalasia. Peroral endoscopic myotomy (POEM) is a less-invasive procedure and offers a quicker recovery. Although some studies have compared short-term outcomes of HM and POEM, predictors of long-term dysphagia resolution remain unclear. The objective of this study was to evaluate patient-reported outcomes for achalasia patients who underwent either POEM or HM over a 9-year period.

Methods

Data from our single academic institutional foregut database were used to identify achalasia patients who underwent HM or POEM from 2009 to 2018. Electronic health record data were reviewed to obtain patient characteristics and operative data. Achalasia severity stages were established for each patient using esophagram findings from an attending radiologist blinded to the procedure type. Postoperative outcomes were assessed via telephone for patients with at least 9 months of follow-up using Eckardt dysphagia scores. Patient age, sex, type of operation, and duration of follow-up were included in a multivariable linear regression model with Eckardt score as the outcome.

Results

Our cohort included 141 patients (97 HM and 44 POEM). Eighty-two patients completed a phone survey at the 9 months or greater time interval (response rate = 58%). Mean Eckardt scores were 2.98 and 2.53 at a median follow-up of 3 years and 1 year for HM and POEM patients, respectively (an Eckardt score ≤ 3 is considered a successful myotomy). Lower stages of achalasia on esophagram (e.g., Stage 0 vs. Stage 4) were associated with greater dysphagia improvement. On multivariable analysis, operative approach was not associated with a statistically significant difference in dysphagia outcomes.

Conclusions

POEM and HM were associated with similar rates of dysphagia resolution for achalasia patients at a median of 2 years of follow-up. Both procedures appear to be durable options for achalasia treatment.

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Funding

Effort on this study and manuscript was made possible by a George H. A. Clowes, Jr., MD, FACS, Memorial Research Career Development Award from the American College of Surgeons and a VA Career Development Award to Dr. Funk (CDA 015-060). The views represented in this article represent those of the authors and not those of the DVA or the US Government.

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Authors and Affiliations

  1. Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, 600 Highland Ave, CSC H4/728, Madison, WI, 53792, USA

    Grace E. Shea, Morgan K. Johnson, Manasa Venkatesh, Sally A. Jolles, Amber L. Shada, Jacob A. Greenberg, Anne O. Lidor & Luke M. Funk

  2. Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA

    Tyler M. Prout

  3. William S. Middleton Memorial VA Hospital, Madison, WI, USA

    Luke M. Funk

Authors
  1. Grace E. Shea
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  2. Morgan K. Johnson
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  3. Manasa Venkatesh
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  4. Sally A. Jolles
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  5. Tyler M. Prout
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  6. Amber L. Shada
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  7. Jacob A. Greenberg
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  8. Anne O. Lidor
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  9. Luke M. Funk
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Contributions

GES, LMF, TMP, MJ, and MV contributed to the study design and data collection. All coauthors participated in the data interpretation and revisions. All coauthors approved the version to be published and agree to be accountable for all aspects of the work and ensure that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Luke M. Funk.

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Disclosures

Effort by Dr. Luke M. Funk on this study was made possible by the George H. A. Clowes, Jr., MD, FACS, Memorial Research Career Development Award from the American College of Surgeons and a VA Career Development Award to Dr. Luke M. Funk (CDA 015-060). The views presented are those of the authors and not those of the DVA or the US Government. Drs. Amber L. Shada, Anne O. Lidor, Jacob A. Greenberg, Tyler M. Prout, and Luke M. Funk, and Ms. Sally A. Jolles, Manasa Venkatesh, Morgan K. Johnson, and Grace E. Shea have no conflicts of interest or financial ties to disclose.

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Shea, G.E., Johnson, M.K., Venkatesh, M. et al. Long-term dysphagia resolution following POEM versus Heller myotomy for achalasia patients. Surg Endosc 34, 1704–1711 (2020). https://doi.org/10.1007/s00464-019-06948-y

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  • DOI: https://doi.org/10.1007/s00464-019-06948-y

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