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.
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.
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.
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