PMID- 33015342 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201006 IS - 2364-3722 (Print) IS - 2196-9736 (Electronic) IS - 2196-9736 (Linking) VI - 8 IP - 10 DP - 2020 Oct TI - How does per-oral endoscopic myotomy compare to Heller myotomy? The Latin American perspective. PG - E1392-E1397 LID - 10.1055/a-1223-1521 [doi] AB - Background and study aims Both Heller myotomy (HM) and per-oral endoscopic myotomy (POEM) are efficacious therapies for achalasia. The efficacy and safety of POEM vs HM in Latin America and specifically in patients with Chagas disease is unknown. Patients and methods Consecutive patients undergoing either HM or POEM for achalasia were included from nine Latin American centers in a prospective registry over 5 years. Technical success was defined as undergoing a successful myotomy. Clinical success was defined as achieving an Eckardt score < 3. Data on demographics, procedure info, Eckardt score, and adverse events (AEs) were collected. Student's t test, Chi squared, and logistic regression analyses were conducted. Results One hundred thirty-three patients were included (59 male; 44 %; mean age 47). POEM was performed in 69 patients, HM in 64 patients. A total of 35 patients had Chagas disease, 17 of 69 in the POEM group, 18 of 64 in the HM group. Both groups had significant reduction in Eckardt scores ( P < 0.00001), but successful initial therapy was significantly higher in the POEM group compared to the HM group ( P = 0.01304). AEs were similar in both group (17 % vs 14 %) and consisted of pneumothorax (n = 3 vs 2), bleeding requiring transfusion (n = 3 vs 2), and mediastinitis (n = 3 vs 1). Hospital stay was longer in the HM group than in the POEM group ( P < 0.00001). In the Chagas subgroup, post-procedure Eckardt score in the POEM group was significantly reduced by 5.71 points ( P < 0.00001) versus 1.56 points in the HM group ( P = 0.042793). Conclusion Both HM and POEM are efficacious for achalasia, but POEM was associated with higher initial therapy success and shorter hospital stay in Latin America. In Chagas patients with achalasia, POEM was significantly more effective than HM. CI - The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). FAU - Kahaleh, Michel AU - Kahaleh M AD - Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States. FAU - Tyberg, Amy AU - Tyberg A AD - Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States. FAU - Suresh, Supriya AU - Suresh S AD - Weill Cornell Medical School, New York, New York, United States. FAU - Lambroza, Arnon AU - Lambroza A AD - Weill Cornell Medical School, New York, New York, United States. FAU - Gaidhane, Monica AU - Gaidhane M AD - Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States. FAU - Zamarripa, Felipe AU - Zamarripa F AD - Hospital Juarez de Mexico, Mexico City, Mexico. FAU - Martinez, Guadalupe Ma AU - Martinez GM AD - Hospital Juarez de Mexico, Mexico City, Mexico. FAU - Carames, Juan C AU - Carames JC AD - Santander Hospital, Reynosa, Mexico. FAU - Moura, Eduardo T AU - Moura ET AD - Hospital das Clinicas, Sao Paulo, Brazil. FAU - Farias, Galileu F AU - Farias GF AD - Hospital das Clinicas, Sao Paulo, Brazil. FAU - Porfilio, Maria G AU - Porfilio MG AD - Hospital Escuela Dr.Ramon Madariaga, Posadas, Argentina. FAU - Nieto, Jose AU - Nieto J AD - Borland-Groover, Jacksonville, Florida, United States. FAU - Rey, Mario AU - Rey M AD - La Policia Hospital, Bogota, Colombia. FAU - Rodriguez Casas, Fernando AU - Rodriguez Casas F AD - La Policia Hospital, Bogota, Colombia. FAU - Mondragon Hernandez, Oscar V AU - Mondragon Hernandez OV AD - Mexican Institute of Social Security, Mexico City, Mexico. FAU - Vargas-Rubio, Romulo AU - Vargas-Rubio R AD - San Ignacio University Hospital, Bogota, Colombia. FAU - Canadas, Raul AU - Canadas R AD - San Ignacio University Hospital, Bogota, Colombia. FAU - Hani, Albis AU - Hani A AD - San Ignacio University Hospital, Bogota, Colombia. FAU - Munoz, Guillermo AU - Munoz G AD - Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States. FAU - Castillo, Bismarck AU - Castillo B AD - Gastromedica Clinic, Managua, Nicaragua. FAU - Lukashok, Hannah P AU - Lukashok HP AD - Ecuadorian Institute of Digestive Diseases, Guayaquil, Ecuador. FAU - Robles-Medranda, Carlos AU - Robles-Medranda C AD - Ecuadorian Institute of Digestive Diseases, Guayaquil, Ecuador. FAU - de Moura, Eduardo G AU - de Moura EG AD - Hospital das Clinicas, Sao Paulo, Brazil. LA - eng PT - Journal Article DEP - 20200922 PL - Germany TA - Endosc Int Open JT - Endoscopy international open JID - 101639919 PMC - PMC7508649 COIS- Competing interests The authors have received research support from Boston Scientific, Interscope, Conmed, Pinnacle, Gore, Merit, and Olympus. EDAT- 2020/10/06 06:00 MHDA- 2020/10/06 06:01 PMCR- 2020/10/01 CRDT- 2020/10/05 06:22 PHST- 2019/11/18 00:00 [received] PHST- 2020/06/12 00:00 [accepted] PHST- 2020/10/05 06:22 [entrez] PHST- 2020/10/06 06:00 [pubmed] PHST- 2020/10/06 06:01 [medline] PHST- 2020/10/01 00:00 [pmc-release] AID - 10.1055/a-1223-1521 [doi] PST - ppublish SO - Endosc Int Open. 2020 Oct;8(10):E1392-E1397. doi: 10.1055/a-1223-1521. Epub 2020 Sep 22.