P1.013. Outcomes of Heller-Dor Myotomy and Per-Oral Endoscopic Myotomy for Esophageal Achalasia

Abstract

Benign Disease: Esophageal Function and Motility Esophageal achalasia is a rare motility disorder. Surgical interventions, including Heller myotomy with Dor fundoplication (HD) and per-oral endoscopic myotomy (POEM), are performed for medically refractory cases. This study aims to evaluate the surgical techniques and clinical outcomes of both procedures in patients treated at a single institution. We reviewed 68 cases of esophageal achalasia (54 HD, 14 POEM). In the HD group (mean age 50.6), 51 underwent laparoscopic surgery. HD involved a 6cm esophageal and 2cm gastric myotomy with Dor fundoplication. The POEM group (mean age 42.6) underwent circular muscle myotomy via a submucosal tunnel. Clinical efficacy was assessed using the Eckardt score and lower esophageal sphincter pressure (LESP). Postoperative reflux esophagitis was evaluated using the Los Angeles (LA) classification. In the HD group, the Eckardt score significantly improved from 5.6 to 1.4 (p<0.001), and LESP decreased from 22.6 to 16.3 mmHg (p=0.017). In the POEM group, the Eckardt score improved from 5.9 to 1.4 (p<0.001), and LESP decreased from 31.2 to 12.3 mmHg (p=0.002). Postoperative reflux esophagitis (Grade A or higher) was significantly more frequent in the POEM group (37.5%) than in the HD group (9.3%; p=0.029); however, all cases were effectively managed medically. Both HD and POEM are effective treatments for esophageal achalasia, providing significant symptomatic relief and reduction in LESP. While POEM is associated with a higher incidence of postoperative reflux esophagitis, both procedures remain valuable therapeutic options.