Pneumatic Dilation Associated With Higher Complication and Readmission Rates in Patients With Achalasia
Prateek Sharma, MD, FASGE, reviewing Haseeb M, et al. Gastrointest Endosc 2023 May.
Data directly comparing treatment options for achalasia are limited, namely peroral endoscopic myotomy (POEM), laparoscopic Heller myotomy (LHM), and endoscopic pneumatic dilation (PD). The current study aimed to assess short-term readmission, adverse events, hospitalization outcomes, repeat intervention requirement, and resource utilization of patients undergoing these treatments.
Investigators analyzed data from the National Readmission Database (2016-2019) on inpatient admissions for patients who underwent POEM, LHM, or PD for achalasia. LHM was the most common procedure (n=9710), followed by PD (n=2453) and POEM (n=1911). Patients who underwent PD were older and had a higher Charlson Comorbidity Index score.
The 30-day readmission rate was 4.3% for POEM, 3.9% for LHM, and 12.6% for PD. The adjusted odds of readmission for PD compared with POEM was 2.42, and there was no statistically significant difference in the odds of readmission for LHM compared with POEM. Among the readmitted patients, 13.1% of those who received PD and 3.4% who underwent LHM required achalasia-related procedural intervention. The rates of bleeding (4.3%), blood transfusion (2.3%), and mortality (1.1%) were higher in PD than in POEM and LHM.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Haseeb M, Khan Z, Kamal MU, Jirapinyo P, Thompson CC. Short-term outcomes after peroral endoscopic myotomy, Heller myotomy, and pneumatic dilation in patients with achalasia: a nationwide analysis. Gastrointest Endosc 2023;97:871-879.e2. (https://doi.org/10.1016/j.gie.2023.01.004)