Comparison of perioperative outcomes between peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy.
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.
Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 650, Chicago, IL 60611, USA. ehungnes@nmh.org
Eric S
ES
Hungness
Ezra N
EN
Teitelbaum
Byron F
BF
Santos
Fahd O
FO
Arafat
John E
JE
Pandolfino
Peter J
PJ
Kahrilas
Nathaniel J
NJ
Soper
D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000601:surgery; D011446:Prospective Studies; D055815:Young Adult