POEM vs laparoscopic Heller-Dor in the treatment for esophageal achalasia: long term results (> 5 years) of a comparative study using propensity score

Aims A recent RCT comparing POEM and laparoscopic Heller-Dor fundoplication (LHD) showed similar outcome results but with both techniques. This was also shown by a previous case-control study with propensity score (PS) by our group. However, both studies were limited by a short follow-up. The aim of the present study was therefore to reassess our patients at a minimum 5-year follow-up.

Methods Two groups of consecutive patients undergoing treatment for primary achalasia from January 2014 to November 2017 were recruited in two high-volume centers, one with extensive experience with POEM and one with LHD. Patients with previous endoscopic treatment were included, whereas patients with previous LHD or POEM were excluded. One-hundred and forty patients for each center were matched with PS (Caliper 0.2). The patients were followed with clinical (Eckardt score), endoscopic, and pH-manometry evaluations. Failure was defined as an Eckardt score<3 or the need for further treatment. Only those patients who reached a minimum 5-year follow-up were considered in this study.

Results A total of 68 patients in the POEM group and 118 in the LHD had at least 5 years of follow-up and formed the study population. One patient in both groups died during the follow-up for causes unrelated to achalasia. At a median follow-up of 79.6 months [IQR 42.1-103.95], 87.3% of the POEM patients and 90.1% of the LHD patients showed an Eckardt score≤3 (p=n.s.). The need for PPIs was higher in the POEM group than in the LHD group (45.6% vs 24.6%, p 0.03) and esophagitis was found in 34% of the POEM and 10.4% of LHD patients (p<0.002) (Table 1). None of the patients developed esophageal cancer.

Conclusions POEM provides the same long-term results as LHD. This study confirms, however, a higher incidence of post-operative GERD with the former, even if its real significance needs to be further evaluated.

 

MissingLinkText

Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025