Per oral endoscopic myotomy and laparoscopic Heller myotomy show similar outcomes in type III achalasia.
Publication Title
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
Document Type
Article
Publication Date
3-1-2026
Keywords
Humans; Esophageal Achalasia; Male; Retrospective Studies; Female; Middle Aged; Heller Myotomy; Treatment Outcome; Adult; Case-Control Studies; Laparoscopy; Myotomy; Reoperation; Aged; Esophageal Sphincter, Lower; Natural Orifice Endoscopic Surgery; EGJOO; Heller myotomy; Per oral endoscopic myotomy; Reinterventions; Type III achalasia.; washington; swedish; swedish digestive health; swedish thoracic surgery
Abstract
BACKGROUND: Achalasia is classified into 3 manometric subtypes with variable treatment response. Guidelines recommend per oral endoscopic myotomy (POEM) over laparoscopic Heller myotomy (LHM) for the treatment of achalasia type III. However, there is limited evidence directly comparing these operations. We aimed to compare the treatment response to POEM vs LHM in type III achalasia.
METHODS: We conducted a retrospective, case-control review of patients undergoing primary myotomy for type III achalasia or achalasia variants with type III features. The primary outcome was symptomatic response assessed using the Eckardt score (ES) with a score of ≤3 classified as success. The secondary outcome was the need for reintervention(s) within 3 years.
RESULTS: There were 46 patients, of whom 16 underwent POEM, and 30 underwent LHM. The groups were similar in demographics, preoperative ESs, and rates of preoperative endoscopic interventions. Both groups had median myotomy lengths of 6 cm (4 cm esophageal and 2 cm gastric). After myotomy, both groups had similar rates of success (14/16 POEM vs 26/30 LHM, P =.94). The primary persisting symptom was dysphagia in both groups. Reinterventions occurred in 4/16 (25%) of POEM patients who underwent 9 reinterventions compared with 5/30 (16.7%) LHM patients who underwent 6 reinterventions (P =.49). Most patients in both groups had symptomatic improvement after their last reintervention.
CONCLUSION: Patients with type III achalasia had similar improvements after undergoing POEM or LHM. There was no difference in reintervention rates between the groups. Patients undergoing reintervention after POEM were more likely to undergo multiple reinterventions.
Area of Special Interest
Digestive Health
Specialty/Research Institute
Gastroenterology
Specialty/Research Institute
Surgery
DOI
10.1016/j.gassur.2026.102331
