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SHORT TERM OUTCOMES FOLLOWING POEM, HELLER MYOTOMY AND PNEUMATIC DILATION IN PATIENTS WITH ACHALASIA: A NATIONWIDE ANALYSIS.

Published:January 10, 2023DOI:https://doi.org/10.1016/j.gie.2023.01.004
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      Abstract

      Background and Aims

      Per-oral endoscopic myotomy (POEM), Laparoscopic Heller Myotomy (LHM), and Pneumatic Dilation (PD) are the most common modalities for management of achalasia. Our study aimed to directly compare their short-term outcomes and safety profile in the hospitalized cohort in the United States.

      Methods

      National Readmission Database (2016-2019) was queried using ICD-10-CM Codes to identify a cohort of inpatient admissions who underwent POEM, LHM or PD. Baseline demographic variables, resource utilization, periprocedural outcomes, and 30-day readmissions were analyzed. A univariate and multivariate logistic regression model was used to compare odds of readmission with POEM as a reference.

      Results

      LHM was the most performed procedure (9710) as compared to PD (2453) and POEM (1911). The patients undergoing PD were older with a higher Charlson Comorbidity Index. The 30-day readmission rate was 4.3 %, 3.9%, and 12.6% for POEM, LHM, and PD, respectively. Compared to POEM, the adjusted odds of readmission for PD was 2.42 (95% CI 1.56-3.75). There was no statistically significant difference in odds of readmission for LHM (0.91 [95% CI 0.62-1.33] compared to POEM. Within 30-day readmitted population, 13.1% of PD and 3.4% of LHM patients required achalasia-related procedural intervention. The rate of bleeding (4.3%), blood transfusion (2.3%), and mortality were higher (1.1%) in PD as compared to POEM and LHM.

      Conclusion

      In the United States, the risk of readmission and resource utilization is higher in patients with achalasia undergoing PD. The outcomes are comparable between POEM and LHM but there is a significant difference between the utilization of these myotomy procedures.
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