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

Journal of Gastrointestinal Surgery volume 17, pages 228–235 (2013)Cite this article

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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References

  1. Francis DL, Katzka DA. Achalasia: update on the disease and its treatment. Gastroenterology 2010;139:369–74.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  9. Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010;42:265–71.

    PubMed  Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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. 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.

    PubMed  Article  Google Scholar 

  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.

    Article  Google Scholar 

  15. Eckardt VF. Clinical presentations and complications of achalasia. Gastrointestinal Endoscopy Clinics of North America 2001; 11: 281–92, vi.

    Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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. 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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    Article  CAS  Google Scholar 

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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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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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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

Keywords

  • Achalasia
  • Peroral endoscopic myotomy
  • Laparoscopic Heller myotomy
  • Natural orifice transluminal endoscopic surgery