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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(10): E1392-E1397
DOI: 10.1055/a-1223-1521
Original article

How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective

Michel Kahaleh
 1   Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
,
Amy Tyberg
 1   Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
,
Supriya Suresh
 2   Weill Cornell Medical School, New York, New York, United States
,
Arnon Lambroza
 2   Weill Cornell Medical School, New York, New York, United States
,
Monica Gaidhane
 1   Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
,
Felipe Zamarripa
 3   Hospital Juarez de Mexico, Mexico City, Mexico
,
Guadalupe Ma Martínez
 3   Hospital Juarez de Mexico, Mexico City, Mexico
,
Juan C. Carames
 4   Santander Hospital, Reynosa, Mexico
,
Eduardo T. Moura
 5   Hospital das Clinicas, Sao Paulo, Brazil
,
Galileu F. Farias
 5   Hospital das Clinicas, Sao Paulo, Brazil
,
Maria G. Porfilio
 6   Hospital Escuela Dr.Ramon Madariaga, Posadas, Argentina
,
Jose Nieto
 7   Borland-Groover, Jacksonville, Florida, United States
,
Mario Rey
 8   La Policia Hospital, Bogota, Colombia
,
Fernando Rodriguez Casas
 8   La Policia Hospital, Bogota, Colombia
,
Oscar V. Mondragón Hernández
 9   Mexican Institute of Social Security, Mexico City, Mexico
,
Romulo Vargas-Rubio
10   San Ignacio University Hospital, Bogota, Colombia
,
Raul Canadas
10   San Ignacio University Hospital, Bogota, Colombia
,
Albis Hani
10   San Ignacio University Hospital, Bogota, Colombia
,
Guillermo Munoz
 1   Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
,
Bismarck Castillo
11   Gastromedica Clinic, Managua, Nicaragua
,
Hannah P. Lukashok
12   Ecuadorian Institute of Digestive Diseases, Guayaquil, Ecuador
,
Carlos Robles-Medranda
12   Ecuadorian Institute of Digestive Diseases, Guayaquil, Ecuador
,
Eduardo G de Moura
 5   Hospital das Clinicas, Sao Paulo, Brazil
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Abstract

Background and study aims Both Heller myotomy (HM) and per-oral endoscopic myotomy (POEM) are efficacious therapies for achalasia. The efficacy and safety of POEM vs HM in Latin America and specifically in patients with Chagas disease is unknown.

Patients and methods Consecutive patients undergoing either HM or POEM for achalasia were included from nine Latin American centers in a prospective registry over 5 years. Technical success was defined as undergoing a successful myotomy. Clinical success was defined as achieving an Eckardt score < 3. Data on demographics, procedure info, Eckardt score, and adverse events (AEs) were collected. Student’s t test, Chi squared, and logistic regression analyses were conducted.

Results One hundred thirty-three patients were included (59 male; 44 %; mean age 47). POEM was performed in 69 patients, HM in 64 patients. A total of 35 patients had Chagas disease, 17 of 69 in the POEM group, 18 of 64 in the HM group. Both groups had significant reduction in Eckardt scores (P < 0.00001), but successful initial therapy was significantly higher in the POEM group compared to the HM group (P = 0.01304). AEs were similar in both group (17 % vs 14 %) and consisted of pneumothorax (n = 3 vs 2), bleeding requiring transfusion (n = 3 vs 2), and mediastinitis (n = 3 vs 1). Hospital stay was longer in the HM group than in the POEM group (P < 0.00001). In the Chagas subgroup, post-procedure Eckardt score in the POEM group was significantly reduced by 5.71 points (P < 0.00001) versus 1.56 points in the HM group (P = 0.042793).

Conclusion Both HM and POEM are efficacious for achalasia, but POEM was associated with higher initial therapy success and shorter hospital stay in Latin America. In Chagas patients with achalasia, POEM was significantly more effective than HM.



Publication History

Received: 18 November 2019

Accepted: 12 June 2020

Article published online:
22 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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