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 1year 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 1year 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 1year (1.1 vs. 3.1, p<0.05). The average myotomy length of type III achalasia patients undergoing POEM was 18.6cm (±6.9) compared to 10.3cm (±1.0) in LHM patients (p<0.01), which may have contributed to this difference. POEM provides a significant quality of life benefit at 1year 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.