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Laparoscopic Heller Myotomy vs Per Oral Endoscopic Myotomy: Patient-Reported Outcomes at a Single Institution.
Hanna, Andrew N; Datta, Jashodeep; Ginzberg, Sara; Dasher, Kevin; Ginsberg, Gregory G; Dempsey, Daniel T.
Afiliação
  • Hanna AN; Department of General Surgery, University of Pennsylvania, Philadelphia, PA.
  • Datta J; Department of General Surgery, University of Pennsylvania, Philadelphia, PA.
  • Ginzberg S; University of Pennsylvania School of Medicine, Philadelphia, PA.
  • Dasher K; Department of Internal Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA.
  • Ginsberg GG; Department of Internal Medicine, Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA.
  • Dempsey DT; Department of General Surgery, University of Pennsylvania, Philadelphia, PA. Electronic address: Daniel.dempsey@uphs.upenn.edu.
J Am Coll Surg ; 226(4): 465-472.e1, 2018 04.
Article em En | MEDLINE | ID: mdl-29410262
BACKGROUND: Although laparoscopic Heller myotomy (LHM) has been the standard of care for achalasia, per oral endoscopic myotomy (POEM) has gained popularity as a viable alternative. This retrospective study aimed to compare patient-reported outcomes between LHM and POEM in a consecutive series of achalasia patients with more than 1 year of follow-up. STUDY DESIGN: We reviewed demographic and procedure-related data for patients who underwent either LHM or POEM for achalasia between January 2011 and May 2016. Phone interviews were conducted assessing post-procedure achalasia symptoms via the Eckardt score and achalasia severity questionnaire (ASQ). Demographics, disease factors, and survey results were compared between LHM and POEM patients using univariate analysis. Significant predictors of procedure failure were analyzed using univariate and multivariate analysis. RESULTS: There were no serious complications in 110 consecutive patients who underwent LHM or POEM during the study period, and 96 (87%) patients completed phone surveys. There was a nonsignificant trend toward better patient-reported outcomes with POEM. There were significant differences in patient characteristics including sex, achalasia type, mean residual lower esophageal pressure (rLESP), and follow-up time. The only univariate predictors of an unsatisfactory Eckardt score or ASQ were longer follow-up and lower rLESP, with follow-up length being the only predictor on multivariate analysis. CONCLUSIONS: There were significant demographic and clinical differences in patient selection for POEM vs LHM in our group. Although the 2 procedures have similar patient-reported effectiveness, subjective outcomes seem to decline as a result of time rather than procedure type.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Acalasia Esofágica / Laparoscopia / Cirurgia Endoscópica por Orifício Natural / Miotomia de Heller Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Surg Assunto da revista: GINECOLOGIA / OBSTETRICIA Ano de publicação: 2018 Tipo de documento: Article País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Acalasia Esofágica / Laparoscopia / Cirurgia Endoscópica por Orifício Natural / Miotomia de Heller Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Surg Assunto da revista: GINECOLOGIA / OBSTETRICIA Ano de publicação: 2018 Tipo de documento: Article País de publicação: Estados Unidos