Outcome of Peroral Endoscopic Myotomy (POEM) for Treating Achalasia Compared With Laparoscopic Heller Myotomy (LHM).
OBJECTIVE
Peroral endoscopic myotomy (POEM) is an emerging endoscopic treatment for achalasia and the long-term efficacy of POEM remains to be evaluated. This study compared the outcomes of POEM with that of the standard laparoscopic Heller myotomy (LHM) for achalasia.


METHODS
Achalasia patients treated by POEM or LHM were retrospectively analyzed, with a minimum postoperative follow-up of 3 years. Perioperative outcomes and long-term outcomes including treatment success (Eckardt score ≤3), occurrence of gastroesophageal reflux disease (GERD) (GerdQ score ≥9) and quality of life (36-item short form) were compared.


RESULTS
Thirteen patients who underwent POEM were compared with 18 patients who received LHM. These patients were similar in age, sex, symptoms duration, Eckardt score, and previous therapy (all P>0.05). Mean myotomy lengths were similar (P=0.73). Operation time was shorter in the POEM group (P=0.001). One patient (7.7%) developed pneumothorax after POEM and 1 patient (5.6%) experienced postoperative infection after LHM (P=1.00). Treatment success was achieved in 83.3% (9/12) of POEM patients and 80.0% (12/15) of LHM patients (P=1.00). Both POEM and LHM significantly reduced Eckardt score (both P=0.00). GERD rate was similar (8.3% vs. 6.7%, P=1.00). There was no difference in all aspects of quality of life between the 2 groups.


CONCLUSIONS
Long-term outcomes indicate that POEM is an effective treatment that is comparable with LHM. More data of randomized trials comparing POEM with LHM will enrich the existing evidence.
Departments of *Gastroenterology ‡Laparoscopic Surgery, Linyi People's Hospital affiliated to Shandong University, Linyi †Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai.
Lijun
L
Peng
Shuni
S
Tian
Chao
C
Du
Ziying
Z
Yuan
Mingxiao
M
Guo
Lin
L
Lu
D000328:Adult; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome