Long‐term outcomes of treatment for achalasia: Laparoscopic Heller myotomy versus POEM

• Published in: Annals of gastroenterological surgery 2024-09, Vol.8 (5), p.750-760
• Main Authors: Fukushima, Naoko, Masuda, Takahiro, Tsuboi, Kazuto, Watanabe, Jun, Yano, Fumiaki
• Format: Article
• Language: English
• Subjects: achalasia; Comparative studies; Dysphagia; Endoscopy; Esophagus; Gastroesophageal reflux; gastroesophageal reflux disease; laparoscopic Heller myotomy; Laparoscopy; Literature reviews; Ostomy; peroral endoscopic myotomy; Review; Success; Surgery
• ISSN: 2475-0328; 2475-0328
• DOI: 10.1002/ags3.12807

Achalasia is a rare esophageal motility disorder characterized by nonrelaxation of the lower esophageal sphincter. Laparoscopic Heller myotomy (LHM) is the gold standard treatment for achalasia. Peroral endoscopic myotomy (POEM), a less invasive treatment, is performed extensively, and the selection of the intervention method remains debatable to date. In addition to the availability of extensive studies on short‐term outcomes, recent studies on the long‐term outcomes of LHM and POEM have shown similar clinical success after 5 y of follow‐up. However, gastroesophageal reflux disease (GERD) was more common in patients who had undergone POEM than in those who had undergone LHM. Moreover, existing studies have compared treatment outcomes in various disease states. Some studies have suggested that POEM is superior to LHM for patients with type III achalasia because POEM allows for a longer myotomy. Research on treatment for sigmoid types is currently in progress. However, the long‐term results comparing LHD and POEM are insufficient, and the best treatment remains controversial. Further research is needed, and treatment options should be discussed with patients and tailored to their individual needs and pathologies. Laparoscopic Heller myotomy (LHM) is the gold standard treatment for achalasia, and peroral endoscopic myotomy (POEM) is performed extensively; however, the selection of the intervention method remains debatable to date. Recent studies have analyzed the long‐term outcomes over 5 y of LHM and POEM. In this review, we draw on previous reports to discuss the long‐term outcomes and future status of LHM and POEM for achalasia.