Umesh Bhagat, MD1, Prashanthi N. Thota, MD1, Siva Raja, MD1, Madhusudhan R.. Sanaka, MD1, Shalini Tripathi, MD2 1Cleveland Clinic Foundation, Cleveland, OH; 2Carolina East Medical Center, New Bern, NC
Introduction: Heller myotomy (HM) is considered the gold standard for treatment of achalasia. Peroral endoscopic myotomy (POEM) is a novel, minimally invasive endoscopic alternative, that is emerging as the dominant treatment option over the past decade. There is paucity of data regarding predictors of complications after these two procedures. Here we aimed to study and compare the predictors of complications of these two procedures from a national database.
Methods: We queried the National Readmission Database (NRD) database from 2015 to 2020, using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system to identify the patients with a primary diagnosis of Achalasia, who underwent HM or POEM. Most common complications like esophageal perforation, subcutaneous emphysema SC, pneumothorax, peritonitis, sepsis, and ICU stay were identified for both groups and combined into one variable. The primary outcome was predictors of complications. Analysis was performed with STATA software. T-test was used for continuous variables and chi-square test was used for categorical variables. Logistic as well as multivariate regression was used to identify risk factors associated with complications.
Results: The study looked at 14918 patients that underwent HM and 2920 patients that underwent POEM for Achalasia. CHF, cardiac arrhythmia, and AKI predicted complications in both groups. In POEM obesity had increased odds of complications compared to HM which interestingly showed decreased odds. In HM pulmonary circulation disorders, neurological disorders and RA had increased risk of complications, which were not significant in patients undergoing POEM.
Discussion: There is data lacking in regard to predictors which increase the risk of complications in patients undergoing these procedures. In this study, certain risk factors were associated with increased adverse events. We attempted to identify these risk factors in this study. Further studies are needed so that these results are validated and patients with certain risk factors undergo procedures that are relatively safe for them and associated with decreased risk of complications.
Umesh Bhagat indicated no relevant financial relationships.
Prashanthi Thota indicated no relevant financial relationships.
Siva Raja indicated no relevant financial relationships.
Madhusudhan Sanaka indicated no relevant financial relationships.
Shalini Tripathi indicated no relevant financial relationships.
Umesh Bhagat, MD1, Prashanthi N. Thota, MD1, Siva Raja, MD1, Madhusudhan R.. Sanaka, MD1, Shalini Tripathi, MD2. P3719 - Predictors of Complications After Heller Myotomy and Peroral Endoscopic Myotomy in Achalasia, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.