Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA, 18510, USA.
Department of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
Surg Endosc. 2023 Jul;37(7):5526-5537. doi: 10.1007/s00464-022-09652-6. Epub 2022 Oct 11.
Previous studies analyzing short-term outcomes for per-oral endoscopic myotomy (POEM) have shown excellent clinical response rates and shorter operative times compared to laparoscopic Heller myotomy (LHM). Despite this, many payors have been slow to recognize POEM as a valid treatment option. Furthermore, comparative studies analyzing long-term outcomes are limited. This study compares perioperative and long-term outcomes, cost-effectiveness, and reimbursement for POEM and LHM at a single institution.
Adult patients who underwent POEM or LHM between 2014 and 2021 and had complete preoperative data with at least one complete follow up, were retrospectively analyzed. Demographic data, success rate, operative time, myotomy length, length of stay, pre- and postoperative symptom scores, anti-reflux medication use, cost and reimbursement were compared.
58 patients met inclusion with 25 undergoing LHM and 33 undergoing POEM. There were no significant differences in preoperative characteristics. Treatment success (Eckardt ≤ 3) for POEM and LHM was achieved by 88% and 76% of patients, respectively (p = 0.302). POEM patients had a shorter median operative time (106 min. vs. 145 min., p = 0.003) and longer median myotomy length (11 cm vs. 8 cm, p < 0.001). All LHM patients had a length of stay (LOS) ≥ 1 day vs. 51.5% for POEM patients (p < 0.001). Both groups showed improvements in dysphagia, heartburn, regurgitation, Eckardt score, GERD HRQL, RSI, and anti-reflux medication use. The improvement in dysphagia score was greater in patients undergoing POEM (2.30 vs 1.12, p = 0.003). Median hospital reimbursement was dramatically less for POEM ($3,658 vs. $14,152, p = 0.002), despite median hospital costs being significantly lower compared to LHM ($2,420 vs. $3,132, p = 0.029).
POEM is associated with a shorter operative time and LOS, longer myotomy length, and greater resolution of dysphagia compared to LHM. POEM costs are significantly less than LHM but is poorly reimbursed.
与腹腔镜 Heller 肌切开术（LHM）相比，先前分析经口内镜肌切开术（POEM）短期结果的研究显示出优异的临床反应率和更短的手术时间。尽管如此，许多付款人仍迟迟没有认识到 POEM 是一种有效的治疗选择。此外，分析长期结果的比较研究有限。本研究比较了单一机构的 POEM 和 LHM 的围手术期和长期结果、成本效益和报销情况。
回顾性分析了 2014 年至 2021 年间接受 POEM 或 LHM 的成年患者，这些患者具有完整的术前数据，并且至少有一次完整的随访。比较了人口统计学数据、成功率、手术时间、肌切开长度、住院时间、术前和术后症状评分、抗反流药物使用、成本和报销情况。
58 名患者符合纳入标准，其中 25 名接受 LHM，33 名接受 POEM。术前特征无显著差异。POEM 和 LHM 的治疗成功率（Eckardt≤3）分别为 88%和 76%的患者（p=0.302）。POEM 患者的中位手术时间更短（106 分钟 vs. 145 分钟，p=0.003），中位肌切开长度更长（11 厘米 vs. 8 厘米，p<0.001）。所有 LHM 患者的住院时间（LOS）≥1 天，而 POEM 患者的 LOS≥1 天的比例为 51.5%（p<0.001）。两组患者的吞咽困难、烧心、反流、Eckardt 评分、GERD HRQL、RSI 和抗反流药物使用均有改善。POEM 组患者的吞咽困难评分改善更显著（2.30 分 vs. 1.12 分，p=0.003）。POEM 的中位医院报销金额明显低于 LHM（3658 美元 vs. 14152 美元，p=0.002），尽管与 LHM 相比，POEM 的中位医院成本明显更低（2420 美元 vs. 3132 美元，p=0.029）。
与 LHM 相比，POEM 具有手术时间和 LOS 更短、肌切开长度更长、吞咽困难更显著缓解的特点。POEM 的成本明显低于 LHM，但报销情况较差。
