B0451 - Achalasia Patients Admitted After Per-Oral Endoscopic Myotomy (POEM) versus Heller’s Myotomy: An American Experience

Dushyant S. Dahiya, MD¹, Mohammad Al-Haddad, MD, MSc², Sumant Inamdar, MD, MPH³, Chin-I Cheng, PhD⁴, Madhusudhan Sanaka, MD^5
1Central Michigan University College of Medicine, Saginaw, MI; ²Indiana University School of Medicine, Indianapolis, IN; ³University of Arkansas for Medical Sciences, Little Rock, AR; ⁴Central Michigan University, Mount Pleasant, MI; ⁵Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH

Introduction: Achalasia is a rare neurodegenerative motility disorder of the esophagus characterized by ineffective lower esophageal sphincter relaxation and peristalsis leading to dysphagia. Heller’s Myotomy (HM) is the gold standard surgical procedure used to treat achalasia. However, Per-Oral Endoscopic Myotomy (POEM), a rapidly emerging minimally invasive endoscopic technique, has gained immense popularity for management of achalasia in recent years. In this study, we aimed to compare the differences for achalasia patients who were admitted to the hospital after POEM or HM in the United States (US).

Methods: The National Inpatient Sample was utilized to identify all adult (≥18 years) achalasia patients who were admitted to the hospital after POEM or HM in the US from 2016–2019. Hospitalization characteristics and clinical outcomes were compared between the two subgroups. P-values ≤0.05 were considered statistically significant.

Results: Between 2016–2019, there were 1,885 and 11,150 achalasia patients who were admitted to the hospital after POEM and HM, respectively. Most of these hospitalizations were primarily at large urban teaching hospitals (Table 1). The mean age for POEM-related hospitalizations was 57.6 years compared to 56.7 years for the HM cohort, without a statistical difference (p=0.13). For achalasia patients hospitalized after POEM, the 65–79 age group had the highest proportion (31.8%) of patients, while the 50–64 age group had the highest proportion (31.3%) of patients for the HM cohort. We noted a significant White predominance in both subgroups (Table 1). Furthermore, a higher proportion of achalasia patients with Charlson Comorbidity Index (CCI) ≥1 were admitted after POEM (43.8 vs 40%, p=0.002) compared to HM. We did not find a statistical difference for the mean length of stay (3.7 vs 3.4 days, p=0.35) and mean total healthcare charge ($66,151 vs $65,468, p=0.07) between achalasia patients who were admitted after POEM or HM (Table 1). Moreover, there was no inpatient mortality for both subgroups.

Discussion: Studies have demonstrated that POEM and HM to be efficacious and safe for management of achalasia. In this study, there was no inpatient mortality for achalasia patients admitted to the hospital after POEM or HM. Furthermore, there was no statistical difference in the mean LOS between the two subgroups. These findings reflect an excellent safety profile of both procedures and similar recovery times. However, POEM is relatively less invasive than HM.



Disclosures:


Dushyant S. Dahiya, MD¹, Mohammad Al-Haddad, MD, MSc², Sumant Inamdar, MD, MPH³, Chin-I Cheng, PhD⁴, Madhusudhan Sanaka, MD⁵. B0451 - Achalasia Patients Admitted After Per-Oral Endoscopic Myotomy (POEM) versus Heller’s Myotomy: An American Experience, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.