S967 Ten-Year Comparative Outcomes of POEM Versus Laparoscopic Heller Myotomy for Achalasia: A Propensity-Matched Analysis From a Multicenter Real-World Database

Introduction: Peroral endoscopic myotomy (POEM) has emerged as a minimally invasive alternative to laparoscopic Heller myotomy (LHM) for achalasia. However, comparative data on long-term outcomes between these modalities remain limited. We aimed to evaluate the 10-year clinical outcomes of POEM versus LHM using a large federated electronic health record database. Methods: We performed a retrospective cohort study using the TriNetX Research Network, including 100 healthcare organizations. Adult patients (≥18 years) with a diagnosis of achalasia (International Classification of Diseases-10: K22.0) who underwent either POEM (Current Procedural Terminology (CPT): 43497) or LHM with fundoplasty (CPT: 43279) were identified. Patients with systemic sclerosis or esophageal cancer were excluded. Propensity score matching (1:1) was applied to balance demographics and comorbidities. Primary outcomes included rates of esophageal perforation, esophagectomy, stricture, dysphagia, aspiration pneumonia, gastroesophageal reflux disease (GERD), percutaneous endoscopic gastrostomy (PEG) placement, mortality, and need for redo POEM. Kaplan-Meier survival and risk analyses were performed over a 10-year period post-procedure. Results: After matching, 4,050 patients were included (2,025 per group). Esophageal perforation rates were similar (1.1% POEM vs 0.7% Heller; P = 0.25). POEM was associated with significantly lower rates of esophagectomy (0% vs 0.5%; P = 0.002), esophageal stricture (3.8% vs 9.0%; P < 0.001), and dysphagia (14.6% vs 21.8%; P = 0.005). Aspiration pneumonia was less frequent in POEM (1.3% vs 2.3%; P = 0.028). GERD incidence was modestly higher in POEM (29.8% vs 26.5%; P = 0.15), accompanied by significantly greater PPI use (68.7% vs 43.8%; P < 0.001). PEG placement trended lower (0.6% vs 1.2%; P = 0.061). All-cause mortality was substantially reduced in POEM (1.8% vs 6.7%; P < 0.001). A small subset of POEM patients (3.7%) underwent repeat POEM during the 10-year follow-up. Conclusion: In this large, multicenter analysis, POEM demonstrated favorable long-term outcomes compared to LHM, with reduced esophagectomy, stricture, dysphagia, aspiration pneumonia, and mortality. Higher GERD rates and redo procedures remain considerations. These results support POEM as a durable and effective therapeutic option for achalasia.