A recent randomized trial (YB Werner et al. NEJM 2019; 381: 2219-29) compared peroral endoscopic myotomy (POEM) and laparoscopic Heller’s myotomy (LHM) for idiopathic achalasia in 221 patients.

Key findings:

• Clinical success at 2-year followup was observed in 83% in the POEM group and 82% in the LHM group. Clinical success was defined as Eckardt score of 3 or less without the use of additional treatments.
• Serious adverse events occurred in 2.7% of POEM group and 7.3% of LHM group
• At 3 months following procedure, 57% of the POEM group and 20% of LHM group had reflux esophagitis; the rates were 44% and 29% at 2 years, respectively.

My take: This study demonstrates similar outcomes between POEM and LHM.  As a practical matter, local expertise is likely a crucial component in choosing between these options.

Related blog posts:

• #NASPGHAN19 Postgraduate Course (Part 3)
• Esophageal Disorders: POEM in Kids, Mitomycin C for Refractory Strictures
• EPT for Achalasia
• POEM for Achalasia in Children
• Poems in practice for achalasia
• Achalasia -Updated Epidemiology | gutsandgrowth