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Erschienen in: Surgical Endoscopy 2/2021

10.03.2020

Long-term outcomes of per-oral endoscopic myotomy compared to laparoscopic Heller myotomy for achalasia: a single-center experience

verfasst von: Alexander J. Podboy, Joo Ha Hwang, Homero Rivas, Dan Azagury, Mary Hawn, James Lau, Afrin Kamal, Shai Friedland, George Triadafilopoulos, Thomas Zikos, John O. Clarke

Erschienen in: Surgical Endoscopy | Ausgabe 2/2021

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Abstract

Introduction

Many centers have reported excellent short-term efficacy of per-oral endoscopic myotomy (POEM) for the treatment of achalasia. However, long-term data are limited and there are few studies comparing the efficacy of POEM versus Heller Myotomy (HM).

Aims

To compare the long-term clinical efficacy of POEM versus HM.

Methods

Using a retrospective, parallel cohort design, all cases of POEM or HM for achalasia between 2010 and 2015 were assessed. Clinical failure was defined as (a) Eckardt Score > 3 for at least 4 weeks, (b) achalasia-related hospitalization, or (c) repeat intervention. All index manometries were classified via Chicago Classification v3. Pre-procedural clinical, manometric, radiographic data, and procedural data were reviewed.

Results

98 patients were identified (55 POEM, 43 Heller) with mean follow-up of 3.94 years, and 5.44 years, respectively. 83.7% of HM patients underwent associated anti-reflux wrap (Toupet or Dor). Baseline clinical, demographic, radiographic, and manometric data were similar between the groups. There was no statistical difference in overall long-term success (POEM 72.7%, HM 65.1% p = 0.417, although higher rates of success were seen in Type III Achalasia in POEM vs Heller (53.3% vs 44.4%, p < 0.05). Type III Achalasia was the only variable associated with failure on a univariate COX analysis and no covariants were identified on a multivariate Cox regression. There was no statistical difference in GERD symptoms, esophagitis, or major procedural complications.

Conclusion

POEM and HM have similar long-term (4-year) efficacy with similar adverse event and reflux rates. POEM was associated with greater efficacy in Type III Achalasia.
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Metadaten
Titel
Long-term outcomes of per-oral endoscopic myotomy compared to laparoscopic Heller myotomy for achalasia: a single-center experience
verfasst von
Alexander J. Podboy
Joo Ha Hwang
Homero Rivas
Dan Azagury
Mary Hawn
James Lau
Afrin Kamal
Shai Friedland
George Triadafilopoulos
Thomas Zikos
John O. Clarke
Publikationsdatum
10.03.2020
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 2/2021
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07450-6

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