title: Outcomes in patients with over 1-year follow-up after peroral endoscopic myotomy (POEM).
abstract: Peroral endoscopic myotomy (POEM) is a promising therapy in the treatment of achalasia. The study was designed to report outcomes, including quality of life, in patients with at least 1-year follow-up.
  
  
  
  Patients from an institutional review board-approved protocol underwent POEM and were followed prospectively. Health-related quality of life was measured preoperatively and 1 year post-operatively using Short Form-36 Health Survey version 2 (SF-36v2). Comparisons were made with patients from a prospective database who underwent laparoscopic Heller myotomy (LHM) over the same period. Paired t tests were used to analyze all normally distributed data, while Wilcoxon signed-rank tests were used to analyze SF-36 data, as it does not follow a normal distribution.
  
  
  
  We analyzed 41 consecutive POEM patients with at least 1-year follow-up. Significant improvements in quality of life between baseline and 1 year were found in role limitations due to physical health (81.8 ± 25.8 vs. 65.9 ± 31.6, p = 0.01) and social functioning (83 ± 19.1 vs. 64.6 ± 31.3, p = 0.01). When compared to 24 patients who underwent LHM, there was no difference in average Eckardt scores (0.9 ± 1.6 vs. 1.0 ± 1.3, p > 0.05) or incidence of PPI use (43.5 vs. 47.5 %, p = 0.71). However, when looking at just type III patients, POEM patients had a higher remission rate (100 vs. 62.5 %) and significantly lower post-operative Eckardt scores at 1 year (1.1 vs. 3.1, p < 0.05). The average myotomy length of type III achalasia patients undergoing POEM was 18.6 cm (±6.9) compared to 10.3 cm (±1.0) in LHM patients (p < 0.01), which may have contributed to this difference.
  
  
  
  POEM provides a significant quality of life benefit at 1 year while having similar relief of dysphagia and post-operative PPI use compared to LHM. Type III achalasia patients may have better outcomes with POEM compared to LHM.
authors.affiliation: Department of Surgery, University of Chicago, 2523 N. California Ave. Apt 3, Chicago, IL, 60647, USA. marcward314@gmail.com.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Ward
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Matt
authors.initials: M
authors.lastname: Gitelis
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Lava
authors.initials: L
authors.lastname: Patel
authors.affiliation: Department of Surgery, University of Chicago, 2523 N. California Ave. Apt 3, Chicago, IL, 60647, USA.
authors.forename: Yalini
authors.initials: Y
authors.lastname: Vigneswaran
authors.affiliation: Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Joann
authors.initials: J
authors.lastname: Carbray
authors.affiliation: Department of Surgery, University of Chicago, 2523 N. California Ave. Apt 3, Chicago, IL, 60647, USA.|Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ujiki
mesh_terms: D016208:Databases, Factual; D004931:Esophageal Achalasia / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
keywords: Achalasia; Eckardt score; Laparoscopic Heller myotomy; Peroral endoscopic myotomy (POEM); Type III achalasia