S899 Management Trends in Hospitalized Patients With Achalasia in the United States

Introduction: Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and dysfunctional peristalsis. The main treatment options are peroral endoscopic myotomy (POEM), laparoscopic Heller’s myotomy (LHM), and pneumatic dilation (PD). Over the past decade, POEM has gained global acceptance, with its use increasing for achalasia. This study examines achalasia management trends from 2011 to 2022. Methods: We performed a descriptive trend analysis using the National Inpatient Sample (NIS) from 2011 to 2022. Achalasia cases were identified using International Classification of Diseases (ICD)-9 code 530.0 and ICD-10 code K22.0. Procedure codes identified LHM, POEM, PD, and esophagectomy. Percentages of patients undergoing each procedure were calculated for 2011-2022, while POEM was assessed from 2016 to 2022, as codes were unavailable before 2016. Annual percent change (APC) and average APC (AAPC) were generated using Joinpoint Regression Software (v.5.0.2, National Cancer Institute) via weighted Bayesian Information Criteria (BIC). Results: We identified 12,740 achalasia cases, representing 63,420 patients when weighted. The mean age was 60.4 years, with 46.7% men. The use of LHM decreased from 45.3% in 2011-2012 to 29.3% in 2021-2022 (AAPC: -4.66; 95% confidence interval [CI] -6 to -3.22; P < 0.001). Esophagectomy declined from 1.5% in 2011-2012 to 0.5% in 2021-2022 (AAPC: -13.61; 95% CI -20.13 to -6.75; P < 0.001). POEM use increased from 5.8% in 2016 to 10.3% in 2022 (AAPC: 7.76; 95% CI 0.02 to 16.41; P = 0.049). PD remained stable from 2011-2014 (P = 0.116), declined from 2014-2017 (APC: -48.45; 95% CI -37.43 to -13.42; P = 0.005), and increased from 2017-2022 (APC: 13.18; 95% CI 3.02 to 44.39; P = 0.014). Conclusion: This study highlights significant shifts in achalasia management over the past decade, with a trend toward less invasive options. POEM’s rise from 2016 to 2022 reflects its growing acceptance as an effective, minimally invasive therapy, while LHM’s decline indicates a preference for newer methods. The decrease in esophagectomy points to a move toward organ preservation, and fluctuating PD trends indicate its continued but limited role. Despite advancements, there is a need for wider dissemination and standardized adoption of evidence-based strategies to optimize outcomes. These trends reflect evolving clinical practices driven by advancements in therapy.