Peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) are established treatments for esophageal motility disorders. However, previous comparative studies have been limited by small sample sizes, restricting generalizability. This study aimed to evaluate perioperative outcomes of POEM and LHM in the United States using a population-based database.

We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) from 2016 to 2022. Patients with achalasia or non-achalasia spastic esophageal disorders who underwent POEM or LHM were included. Inverse probability of treatment weighting (IPTW) analysis was applied to enhance comparability across treatments. Trends in the number of procedures and assessed outcomes included serious adverse events (SAEs), reintervention, mortality, length of stay, and cost.

A total of 18,694 patients were identified (6,554 POEM and 12,140 LHM). Overall rates of SAEs, reintervention, and 30-day mortality were 7.9%, 5.0%, and 0.08%, respectively. IPTW analysis revealed significantly lower rates of SAEs (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.70–0.88) and reintervention (OR 0.79, 95% CI 0.68–0.93) in the POEM group. Length of stay and cost were also more favorable in the POEM group. Mortality was not significantly different (P = 0.97). Subgroup analysis supported these findings when considering either achalasia (n = 15,971) or non-achalasia spastic esophageal disorders (n = 2,723) individually.

In this nationwide cohort, LHM remained more commonly performed in the United States. However, our results confirm that POEM demonstrated favorable outcomes in management of esophageal motility disorders.

Received: 14 June 2025

Accepted after revision: 02 August 2025

Accepted Manuscript online:
04 August 2025

Article published online:
27 August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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Bibliographical Record
Yasutoshi Shiratori, Neha Sharma, Syed Matthew Kodilinye, Carla Barberan Parraga, Sarah Meribout, Aaron Tokayer, Susan Hutfless, Anthony Kalloo. Comparing peroral endoscopic myotomy and laparoscopic Heller myotomy for esophageal motility disorders: Nationwide cohort study. Endosc Int Open 2025; 13: a26764230.
DOI: 10.1055/a-2676-4230