TY - JOUR
T1 - Comparison of Perioperative Outcomes Between Peroral Esophageal Myotomy (POEM) and Laparoscopic Heller Myotomy
AU - Hungness, Eric S.
AU - Teitelbaum, Ezra N.
AU - Santos, Byron F.
AU - Arafat, Fahd O.
AU - Pandolfino, John E.
AU - Kahrilas, Peter J.
AU - Soper, Nathaniel J.
PY - 2013/2
Y1 - 2013/2
N2 - 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.
AB - 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.
KW - Achalasia
KW - Laparoscopic Heller myotomy
KW - Natural orifice transluminal endoscopic surgery
KW - Peroral endoscopic myotomy
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U2 - 10.1007/s11605-012-2030-3
DO - 10.1007/s11605-012-2030-3
M3 - Article
C2 - 23054897
AN - SCOPUS:84872599875
SN - 1091-255X
VL - 17
SP - 228
EP - 235
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 2
ER -