Per Oral Endoscopic Myotomy is Associated with Higher Infectious Complications than Heller Myotomy but Remains Low Overall

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Institutions: Tower Health, USA; Saint Louis University, USA; Cleveland Clinic, USA. Disclosure compliance: I understand. Participant disclosure: Parth Desai: NO financial relationship with a commercial interest; Ameya Deshmukh: NO financial relationship with a commercial interest; Zidong Zhang: NO financial relationship with a commercial interest; Eugene Nwankwo: NO financial relationship with a commercial interest; Madhusudhan Sanaka: NO financial relationship with a commercial interest; Antonio Cheesman Rocca: NO financial relationship with a commercial interest. Introduction: Per Oral Endoscopic Myotomy (POEM) as a minimally invasive treatment modality has been increasingly adopted in the current management of achalasia. Although literature has reported peri-procedural outcomes similar to Heller Myotomy (HM), there is no comparative analysis of adverse outcomes nationally. The aim of this study was to assess and compare the rates of peri-procedural adverse events in POEM and HM in the United States population using the Nationwide Inpatient Sample database. Methods: We conducted a cross-sectional study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database of years 2017 and 2019. Patients hospitalized with primary discharge diagnosis of achalasia (identified using ICD-10 code K22.0) and treated with either POEM (ICD-10-PCS: 0D847ZZ, 0D848ZZ) or Heller myotomy (ICD-9-CM: 42.7; ICD-10-PCS: 0D840ZZ, 0D843ZZ, 0D844ZZ; CPT: 43279, 43330, 43331, S2079) were analyzed. Incidences of the pooled peri-procedural complications were compared between the POEM and HM. Infectious complications included sepsis, bacteremia, and pneumonia. Pulmonary complications included aspiration and acute respiratory failure. Cardiovascular complications included cardiac arrest and cardiogenic shock. Gastrointestinal complications included esophageal perforation or injury. Thromboembolic complications included pulmonary embolism and DVT. Baseline characteristics and outcomes were compared between groups using two-tailed Rao-Scott Chi-square tests with alpha equal to 0.05. All statistical analyses were conducted in SAS 9.4. Findings: A total of 1323 achalasia admissions were included, representing an estimated weighted total N=6615 admissions. Of these admissions, 1104 had HM, while 219 had POEM. A higher proportion of patients undergoing POEM were over 65 years of age (45% vs 35.4%, P= 0.04), while a higher proportion of patients undergoing HM were obese (16.8% vs 11.4%, P=0.03). Distributions of Charleson Comorbidity index were similar between groups [Table 1]. A higher proportion of infectious complications occurred in the POEM group (3.7% vs 1.4%, p=0.01). Pneumonia was more common in the POEM group vs the HM group (1.8% vs 0.5%, p=0.02), while sepsis and bacteremia were similar [Table 2]. Rates of pulmonary, cardiovascular, gastrointestinal, thrombotic, and renal complications were similar between the groups. Incidence of discharge mortality was low overall and no association with procedure type was found. Conclusions: POEM was associated with higher rates of infectious complications than HM, largely driven by higher rates of pneumonia. While overall rates of infectious complications were low, the higher rate in the POEM group may be attributable to the lack of a sterile field during the procedure. Further studies are warranted to determine reasons for infectious complications and how to mitigate them. [Formula presented] Table 1: Baseline Characteristics of Patients Admitted for Heller Myotomy and Per Oral Endoscopic Myotomy [Formula presented] Table 2: Peri-procedural Adverse Events of Patients undergoing Heller Myotomy and Per Oral Endoscopic Myotomy.

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Gastrointestinal Endoscopy




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