Evidence map›Paper›PMID 36220985›Full record

ArticleSurgical endoscopy2023

Clinical and financial outcomes of per-oral endoscopic myotomy compared to laparoscopic heller myotomy for treatment of achalasia.

Lena Shally, Kashif Saeed, Derek Berglund, Mark Dudash, Katie Frank, Vladan N Obradovic, Anthony T Petrick, David L Diehl, Jon D Gabrielsen, David M Parker

Abstract read
PubMed Publisher
In one paragraph

Article in Surgical endoscopy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 4 pooled it
2.1field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 4 syntheses or guidelines pooled it, 15 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Article
  6. Review
  7. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 2 institutions in 1 country.

Lena ShallyGeisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA, 18510, USA. lshally@som.geisinger.edu.
Kashif SaeedDepartment of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
Derek BerglundDepartment of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
Mark DudashDepartment of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
Katie FrankDepartment of Population Health and Sciences, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
Vladan N ObradovicDepartment of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
Anthony T PetrickDepartment of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
David L DiehlDepartment of Gastroenterology and Nutrition, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
Jon D GabrielsenDepartment of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
David M ParkerDepartment of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA.
Geisinger Medical Center · USCommonwealth Medical College · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPrevious 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.

methodsAdult 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.

results58 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).

resultsPOEM 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.

Indexed as

Deglutition DisordersEsophageal AchalasiaGastroesophageal RefluxHeller MyotomyLaparoscopyMyotomyNatural Orifice Endoscopic SurgeryAdultEsophageal Sphincter, LowerHumansRetrospective StudiesTreatment OutcomeAchalasiaDysphagiaLaparoscopic Heller myotomyPer-oral endoscopic myotomySymptomatic treatment

Identifiers

PMID36220985
OpenAlexW4304203470

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.