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

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.