# Comparing peroral endoscopic myotomy and laparoscopic Heller myotomy for esophageal motility disorders: Nationwide cohort study

## TL;DR

This study compares two treatments for esophageal motility disorders using a large U.S. database to determine which has better outcomes.

## Contribution

The study provides a large-scale, population-based comparison of POEM and LHM outcomes in the U.S.

## Key findings

- POEM had significantly lower rates of serious adverse events and reintervention compared to LHM.
- POEM was associated with shorter hospital stays and lower costs than LHM.
- Mortality rates were not significantly different between the two procedures.

## Abstract

Peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) are established treatments for esophageal motility disorders. However, previous comparative studies have been limited by small sample sizes, restricting generalizability. This study aimed to evaluate perioperative outcomes of POEM and LHM in the United States using a population-based database.

We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) from 2016 to 2022. Patients with achalasia or non-achalasia spastic esophageal disorders who underwent POEM or LHM were included. Inverse probability of treatment weighting (IPTW) analysis was applied to enhance comparability across treatments. Trends in the number of procedures and assessed outcomes included serious adverse events (SAEs), reintervention, mortality, length of stay, and cost.

A total of 18,694 patients were identified (6,554 POEM and 12,140 LHM). Overall rates of SAEs, reintervention, and 30-day mortality were 7.9%, 5.0%, and 0.08%, respectively. IPTW analysis revealed significantly lower rates of SAEs (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.70–0.88) and reintervention (OR 0.79, 95% CI 0.68–0.93) in the POEM group. Length of stay and cost were also more favorable in the POEM group. Mortality was not significantly different (
P
 = 0.97). Subgroup analysis supported these findings when considering either achalasia (n = 15,971) or non-achalasia spastic esophageal disorders (n = 2,723) individually.

In this nationwide cohort, LHM remained more commonly performed in the United States. However, our results confirm that POEM demonstrated favorable outcomes in management of esophageal motility disorders.