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Background <p>All studies in the literature comparing POEM and laparoscopic Heller-Dor fundoplication (LHD) for achalasia are limited by a short follow-up. The aim of the study was to reassess the patients of our study at a minimum 5-year follow-up.</p> Methods <p>Two groups of consecutive patients undergoing treatment for primary achalasia between 2014 and 2017 were recruited in two high-volume centers, one with extensive experience with POEM and one with LHD, and were matched with a propensity score. Only those patients who reached a minimum 5-year follow-up were considered in this study.</p> Results <p>A total of 68 patients in the POEM group and 118 in the LHD formed the study population. One patient in each group died during follow-up for causes unrelated to achalasia. At a median follow-up of 79.6&#xa0;months (IQR 42.1–103.95), 87.3% of the POEM patients and 90.1% of the LHD patients showed an Eckardt score ≤ 3 (<i>p</i> = n.s.). The need for PPIs (45.6% vs 24.6%, <i>p</i> = 0.03) and the rate of esophagitis (34% vs 10.4%, <i>p</i> &lt; 0.002) were higher in the POEM group. None of the patients developed esophageal cancer. The disease-free curve estimates at 1–3–5&#xa0;years were similar in the 2 groups (99–98–96% vs 99–96–96%, <i>p</i> = 0.50). At a minimum 5-year follow-up, only 9 patients in the POEM group and 12 patients in the LHD group had symptomatic recurrence.</p> Conclusion <p>POEM provides the same long-term results as LHD. This study confirms, however, a higher incidence of postoperative GERD with the former, even if its real significance needs to be further evaluated.</p>

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Five-year follow-up results of the Italian case–control study comparing poem and laparoscopic Heller myotomy using the propensity score

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  • 发表日期：

    2026年5月21日

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  • Andrea Costantini,
  • Francesca Mangiola,
  • Giovanni Capovilla,
  • Rosario Landi,
  • Luca Provenzano,
  • Loredana Nicoletti,
  • Michele Valmasoni,
  • Cristiano Spada,
  • Mario Costantini,
  • Pietro Familiari,
  • Renato Salvador

摘要

Background

All studies in the literature comparing POEM and laparoscopic Heller-Dor fundoplication (LHD) for achalasia are limited by a short follow-up. The aim of the study was to reassess the patients of our study at a minimum 5-year follow-up.

Methods

Two groups of consecutive patients undergoing treatment for primary achalasia between 2014 and 2017 were recruited in two high-volume centers, one with extensive experience with POEM and one with LHD, and were matched with a propensity score. Only those patients who reached a minimum 5-year follow-up were considered in this study.

Results

A total of 68 patients in the POEM group and 118 in the LHD formed the study population. One patient in each group died during follow-up for causes unrelated to achalasia. At a median follow-up of 79.6 months (IQR 42.1–103.95), 87.3% of the POEM patients and 90.1% of the LHD patients showed an Eckardt score ≤ 3 (p = n.s.). The need for PPIs (45.6% vs 24.6%, p = 0.03) and the rate of esophagitis (34% vs 10.4%, p < 0.002) were higher in the POEM group. None of the patients developed esophageal cancer. The disease-free curve estimates at 1–3–5 years were similar in the 2 groups (99–98–96% vs 99–96–96%, p = 0.50). At a minimum 5-year follow-up, only 9 patients in the POEM group and 12 patients in the LHD group had symptomatic recurrence.

Conclusion

POEM provides the same long-term results as LHD. This study confirms, however, a higher incidence of postoperative GERD with the former, even if its real significance needs to be further evaluated.