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Outcomes in patients with over 1-year follow-up after peroral endoscopic myotomy (POEM)

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Funding

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Authors and Affiliations

  1. Department of Surgery, University of Chicago, 2523 N. California Ave. Apt 3, Chicago, IL, 60647, USA

    Marc A. Ward, Yalini Vigneswaran & Michael B. Ujiki

  2. Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA

    Matt Gitelis, Lava Patel, Joann Carbray & Michael B. Ujiki

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  1. Marc A. Ward
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  2. Matt Gitelis
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Correspondence to Marc A. Ward.

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Disclosure

Dr. Ward, Mr. Gitelis, Dr. Patel, Dr. Vigneswaran, Mrs. Carbray, and Dr. Ujiki have no conflicts of interest or financial ties to disclose.

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Ward, M.A., Gitelis, M., Patel, L. et al. Outcomes in patients with over 1-year follow-up after peroral endoscopic myotomy (POEM). Surg Endosc 31, 1550–1557 (2017). https://doi.org/10.1007/s00464-016-5130-4

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