Retrospective review reveals comparable symptom relief between Heller-Dor and per-oral endoscopic myotomy for achalasia, indicating higher reflux rates after endoscopy.
Key Points
To evaluate the surgical techniques and clinical outcomes of Heller myotomy with Dor fundoplication versus per-oral endoscopic myotomy in patients with esophageal achalasia.
Retrospective review of 68 patients with esophageal achalasia treated at a single institution (54 undergoing Heller-Dor [HD] and 14 undergoing per-oral endoscopic myotomy [POEM]).
HD involved a 6-cm esophageal and 2-cm gastric myotomy with Dor fundoplication (mostly laparoscopic, n=51), while POEM utilized circular muscle myotomy through a submucosal tunnel.
Outcomes measured included Eckardt score, lower esophageal sphincter pressure (LESP), and postoperative reflux esophagitis via Los Angeles classification.
Eckardt scores improved significantly in both the HD group (from 5.6 to 1.4, p < 0.001) and the POEM group (from 5.9 to 1.4, p < 0.001).
Lower esophageal sphincter pressure decreased significantly in both cohorts: HD (from 22.6 to 16.3 mmHg, p = 0.017) and POEM (from 31.2 to 12.3 mmHg, p = 0.002).
Postoperative reflux esophagitis (Grade A or higher) occurred more frequently after POEM (37.5%) compared to HD (9.3%, p = 0.029), though all cases were medically managed.