title: Comparison of early outcomes and quality of life after laparoscopic Heller's cardiomyotomy to peroral endoscopic myotomy for treatment of achalasia.
abstract: OBJECTIVE
  This retrospective cohort study compared clinical outcomes and quality of life after peroral endoscopic myotomy (POEM) against laparoscopic Heller myotomy (LHM) for treatment of achalasia.
  
  
  METHODS
  Patient demographics, operation time, intraoperative blood loss, hospital stay, time to resume diet and analgesic requirement were recorded. Clinical outcomes including recurrence of dysphagia, need for reintervention, and occurrence of gastroesophageal reflux disease (GERD) were recorded.
  
  
  RESULTS
  From 2001 to 2014, 33 patients underwent POEM whereas 23 patients received LHM. Patients LHM had with longer mean operative time (P = 0.02), more blood loss (P = 0.001) and higher requirement for analgesics (P = 0.009) than those treated by POEM. Hospital stay and time to resume diet were similar. Both POEM and LHM achieved similar dysphagia scores at postoperative 4 weeks, 3 months and 6 months. Twenty-six percent of LHM patients and 15.2% of POEM patients sustained gastroesophageal reflux disease (GERD) after treatment (P = 0.311). Six patients required regular proton pump inhibitor three after POEM and three after LHM (P = 0.639). Thirteen percent of LHM patients sustained recurrent dysphagia and one required reintervention. There was no recurrence in the POEM group. Follow-up duration (mean [SD]) for the LHM group was significantly longer (60 [42] months vs 6 [4] months; P = 0.001). There was also no difference in all four aspects of GERD-related quality of life outcomes.
  
  
  CONCLUSIONS
  Compared to LHM, POEM achieved shorter operative time, less blood loss and pain. POEM is comparable to LHM for treatment of achalasia with similar incidence of GERD after the procedure.
authors.affiliation: Departments of Surgery.
authors.forename: Shannon Melissa
authors.initials: SM
authors.lastname: Chan
authors.affiliation: Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Justin Che Yuen
authors.initials: JC
authors.lastname: Wu
authors.affiliation: Departments of Surgery.
authors.forename: Anthony Yuen Bun
authors.initials: AY
authors.lastname: Teoh
authors.affiliation: Departments of Surgery.
authors.forename: Hon Chi
authors.initials: HC
authors.lastname: Yip
authors.affiliation: Departments of Surgery.
authors.forename: Enders Kwok Wai
authors.initials: EK
authors.lastname: Ng
authors.affiliation: Departments of Surgery.
authors.forename: James Yun Wong
authors.initials: JY
authors.lastname: Lau
authors.affiliation: Departments of Surgery.
authors.forename: Philip Wai Yan
authors.initials: PW
authors.lastname: Chiu
mesh_terms: D000328:Adult; D004931:Esophageal Achalasia / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008365:Manometry; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D061646:Operative Time; D011184:Postoperative Period; D011312:Pressure; D011788:Quality of Life; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Heller's cardiomyotomy; achalasia; peroral endoscopic myotomy (POEM)