Peroral endoscopic myotomy: A short-term comparison with the standard laparoscopic approach.
BACKGROUND
We report our short-term experience with peroral endoscopic myotomy (POEM) and compare perioperative outcomes with laparoscopic Heller myotomy (LHM) for achalasia.


METHODS
Patients from an institutional review board-approved protocol underwent POEM and were followed prospectively. Comparisons were made, in a prospective esophageal database, with patients who underwent LHM over the same period.


RESULTS
We studied 18 patients who underwent POEM and compared them to 21 who underwent LHM. Demographics, preoperative Eckardt scores, motility data, and prior intervention history were comparable. Operative time, myotomy length, and complication rates (1 perforation in each group) were equal. Postoperative pain was significantly different by visual analogue score (POEM 3.9 ± 0.6 versus LHM 5.7 ± 0.4, P = .02) and analgesic use (POEM 26.0 ± 13.7 versus LHM 90.0 ± 48.5 mg morphine, P = .02). Return to activities of daily living was significantly faster in the POEM group (2.2 ± 0.6 vs 6.4 ± 1.0 days, P = .03). Postoperative dysphagia and Eckardt scores were equally successful in both groups.


CONCLUSIONS
POEM results in similar relief of dysphagia with less postoperative pain and quicker return to normal activities.
Department of Surgery, Section of Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston, IL. Electronic address: mujiki@northshore.org.
Michael B
MB
Ujiki
Amy K
AK
Yetasook
Matthew
M
Zapf
John G
JG
Linn
Joann M
JM
Carbray
Woody
W
Denham
D000368:Aged; D004931:Esophageal Achalasia / Q000523:psychology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D013352:Subcutaneous Emphysema / Q000209:etiology