P04.3. Long-Term Outcomes of Peroral Endoscopic Versus Laparoscopic Myotomy for Achalasia: A Population-Based Cohort Study
Year: 2026
Type: conference-abstract
Abstract: Topic Benign Disease: Esophageal Function and Motility Background Randomised clinical trials have demonstrated non-inferiority of peroral endoscopic myotomy (POEM) to laparoscopic Heller myotomy (LHM) in the treatment of achalasia. However, there is a lack of long-term follow-up data from population-based cohorts comparing POEM to LHM. We aimed to determine long-term rates of reintervention and reflux following POEM and LHM. Methods This was a population-based cohort study including all adults with achalasia who underwent either primary POEM or primary LHM between 1st January 1997 and 31st December 2024 in Sweden. POEM was the exposure, with LHM considered the comparison in all analyses. The primary outcome was reintervention for achalasia, defined as and subsequent myotomy (peroral or transabdominal), pneumatic dilatation, or oesophagectomy occurring during follow-up. The secondary outcome was gastroesophageal reflux, defined as the dispensation of a proton pump inhibitor equivalent to 36 months use after the primary procedure, or antireflux surgery. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) for both outcomes adjusted for age, sex, Charlson comorbidity index score, and calendar year. Results In total, 991 patients (median age 48 years [IQR 34-61], 58.1% male) with primary POEM or LHM for achalasia were included and followed for up to 14 (median 5.9) years. Of these, 381 (38.4%) patients underwent POEM and 610 (61.6%) underwent LHM. The cumulative incidence of reintervention was 18.6% (n=184) and gastroesophageal reflux occurred in 46.6% (n=462). POEM was associated with a similar risk of reintervention (HR 0.74, 95% CI 0.51-1.08), but the risk of gastroesophageal reflux disease was 40% increased after POEM (HR 1.40, 95% CI 1.11-1.77) as compared to LHM. Conclusion POEM and LHM have comparable long-term treatment durability for the management of achalasia. However, patients undergoing POEM have a higher risk of gastroesophageal reflux and so should be counselled regarding the potential need for long-term antireflux medications.
Source: Diseases of the Esophagus
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7203944216