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Brief Report Comparison of peroral endoscopic myotomy, laparoscopic Heller myotomy, and pneumatic dilation for patients with achalasia: a United States national experience
Dushyant Singh Dahiya1,orcid, Bhanu Siva Mohan Pinnam1orcid, Saurabh Chandan2orcid, Hassam Ali3orcid, Manesh Kumar Gangwani4orcid, Amir Humza Sohail5orcid, Dennis Yang2orcid, Amit Rastogi1orcid
Clinical Endoscopy 2025;58(1):153-157.
DOI: https://doi.org/10.5946/ce.2024.103
Published online: December 24, 2024

1Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS, USA

2Center for Interventional Endoscopy, Advent Health, Orlando, FL, USA

3Division of Gastroenterology, Hepatology & Nutrition, East Carolina University/Brody School of Medicine, Greenville, NC, USA

4Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

5Department of Surgery, University of New Mexico, Albuquerque, NM, USA

Correspondence: Dushyant Singh Dahiya Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, 2000 Olathe Blvd, Kansas City, KS 66160, USA E-mail: dush.dahiya@gmail.com
• Received: April 28, 2024   • Revised: August 4, 2024   • Accepted: August 5, 2024

© 2025 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Achalasia is a rare neurodegenerative disorder characterized by insufficient lower esophageal sphincter (LES) relaxation coupled with inefficient peristalsis, leading to functional obstruction at the gastroesophageal junction.1 Globally, the prevalence of achalasia is around 9 per 100,000 persons.2 Management of achalasia is focused on symptom control and maintenance of nutritional status.1-3 Pneumatic dilation (PD), peroral endoscopic myotomy (POEM), and laparoscopic Heller myotomy (LHM) are viable treatment options that are frequently employed for managing achalasia.1,3,4 In the United States (US), achalasia-related hospitalizations and readmissions are on the rise, with healthcare costs estimated to exceed $408 million in 2018.5 Nevertheless, there continues to be a substantial paucity of data on clinical outcomes of PD, POEM, and LHM among patients hospitalized for achalasia in the US. Hence, this study was designed to assess and compare readmission rates, hospitalization outcomes, adverse events, requirements for repeat procedures, and healthcare utilization for achalasia hospitalizations undergoing PD, POEM, and LHM in the US.
This study derived data from the Nationwide Readmissions Database (NRD), which is one of the largest, publicly available, multi-ethnic readmission databases in the US. For each calendar year, NRD contains weighted discharge information from US states, which can be used to derive national estimates. Within the database, patients are tracked using unique identifier numbers that are not linked to patient or hospital data. Hence, all data are de-identified to maintain patient privacy. We utilized the NRD from 2016–2020 to identify all adult (≥18 years) hospitalizations with a principal diagnosis of achalasia and those with a principal diagnosis of dysphagia, esophageal obstruction, food impaction, or aspiration pneumonia combined with a coexisting diagnosis of achalasia. Among these admissions, patients undergoing PD, POEM, and LHM were identified. Patients <18 years of age and those with esophageal or gastric cancer were excluded from this study. For the 2016–2020 years, the NRD was coded using the International Classification of Diseases, Tenth Revision codes. Analysis was performed using Stata ver. 18 software (StataCorp) using weighted samples for national estimates. Patients in the LHM and PD cohorts were compared with those in the POEM cohort. A univariate regression analysis was performed with outcomes as dependent variables and potential confounders as independent predictors. A p-value of 0.2 was considered to imply a possible association, and these variables were adjusted for in the multivariate regression model. A multivariate regression analysis was performed to calculate the odds of all-cause readmission, inpatient mortality, mean length of stay (LOS), and mean total hospital charge (THC) after adjusting for age, sex, type of insurance, mean household income, hospital characteristics, and medical comorbidities (i.e., heart failure, hypertension, renal disease, tobacco use, malnutrition, and chronic obstructive pulmonary disease were found to be significantly associated confounders), as well as Charlson comorbidity index (CCI). THC from 2016–2020 was adjusted for inflation in the healthcare sector using the consumer price index inflation calculator maintained by the US Bureau of Labor Statistics. Multivariate linear and logistic regression were used to compare continuous and categorical variables, respectively. A 2-sided p<0.05 was considered to represent statistical significance. The NRD lacks patient and hospital-specific identifiers. Therefore, institutional review board approval was not required. The NRD lacks specific patient identifiers. Hence, patient consent was not required.
Between 2016 and 2020, there were 2,922 PD, 2,343 POEM, and 11,345 LHM procedures performed for 16,610 index achalasia admissions in the US. All-cause 30-day readmission rates were 12.34, 4.28, and 3.63% for the PD, POEM, and LHM cohorts, respectively. Patients with achalasia who underwent PD had significantly higher odds of readmission than those in the POEM cohort (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.72–3.58; p<0.001). We did not detect a statistical difference in readmission rates between POEM and LHM cohorts.
Furthermore, we did detect any statistically significant difference in all-cause mortality rates between POEM and PD (0.2% vs. 1.08%; adjusted ORs [aOR], 1.71; 95% CI 0.34–8.61; p=0.514) and POEM and LHM cohorts (0.2% vs. 0.16%; aOR, 1.40; 95% CI, 0.20–9.83; p=0.733). However, patients in the PD cohort had a longer mean LOS than those in the POEM cohort (6.43 vs. 3.2 days, differences on regression 2.07 days; 95% CI, 1.54–2.6; p<0.001) on index admission. The difference in the LOS between the POEM and LHM cohorts was not statistically significant.
After adjusting for confounders, compared with patients in the POEM cohort, patients in the PD cohort exhibited significantly higher odds for the need for blood transfusion (0.7% vs. 2.27%; aOR, 2.16; 95% CI, 1.02–4.55; p=0.043) and intensive care unit (ICU) care (1.52% vs. 3.86%; aOR, 2.12; 95% CI, 1.12–4.02; p=0.02). Additionally, patients in the PD cohort had higher odds for esophageal perforation, periprocedural hemorrhage, and sepsis than those in the POEM cohort; however, after adjusting for confounders, these differences were non-significant. The POEM and LHM cohorts showed no significant differences in the odds for needing blood transfusion, ICU care, esophageal perforation, periprocedural hemorrhage, and sepsis. Figure 1 summarizes the periprocedural adverse events.
Upon readmission, a higher proportion (16.2%) of patients in the PD cohort underwent additional procedures. Of these, 8.49% underwent repeat PD, 7.33% underwent LHM, and 0.38% underwent POEM. Conversely, a relatively smaller proportion of patients undergoing POEM (5.66%) and LHM (3.61%) required additional procedures on readmission. Hospitalization characteristics and a summary of findings are outlined in Tables 1 and 2.
The reasons for 30-day readmissions differed significantly between the three cohorts. In the PD cohort, 37.03% of all 30-day readmissions were for achalasia management, compared with 14.76% and 9.49% in the LHM and POEM cohorts, respectively. Table 3 highlights the other commonly identified causes of readmission.
Our study provides therapeutic endoscopists with a bird’s-eye view of US-based hospitalization data among patients undergoing PD, POEM, and LHM for achalasia. In our study, LHM was the most common procedure performed. Patients undergoing LHM and POEM had comparable 30-day readmission rates, all-cause mortality, odds of complications, LOS, and THC; however, we noted higher rates of these outcomes in the PD cohort. Furthermore, patients in the PD cohort required additional interventions upon readmission.
Between 2016 and 2017, Gupta et al.6 reported that the 30-day readmission rates of PD, POEM, and LHM were 25.6, 6.67, and 5.99%, respectively, without statistically significant differences in the odds of readmission between POEM and LHM. Similarly, Haseeb et al.7 (2016–2019) did not detect a difference in the odds of readmission between achalasia hospitalizations that underwent POEM and LHM. However, the authors reported substantially lower 30-day readmission rates for POEM (4.3%) and LHM (3.9%) than those reported previously, while the 30-day readmission rate for PD was markedly higher at 12.6%.7 Our results are also in line with these findings, given the 30-day readmission rates of 12.34, 4.28, and 3.63% for the PD, POEM, and LHM cohorts, respectively, between 2016 and 2020.
Studies with long-term follow-ups have revealed that POEM is a highly effective and safe procedure for achalasia.7-9 A recent national database study by Haseeb et al.7 reported a mortality rate of 0% for POEM versus 1.8% for LHM. Hence, the authors concluded that POEM was safer than LHM.7 Our study contradicts these findings. Although we noted that the POEM cohort had a higher all-cause mortality rate than the LHM cohort (0.2% vs. 0.16%, respectively), the difference between the two was not statistically significant.
From a complication perspective, PD was noted to have the highest odds of complications (Table 2), although these were comparable among patients in the POEM and LHM cohorts. We noted that the PD cohort also had higher odds of needing ICU care than the POEM cohort–a finding that has not been reported previously. These findings must be interpreted in light of the fact that the PD cohort had a higher proportion of patients with a high comorbidity burden (25.58% with a CCI score ≥3). Hence, it is plausible that after initial evaluation, these patients may have been deemed poor candidates for POEM or LHM, thereby undergoing PD for achalasia management.
Limitations of our study include its retrospective nature, inability to characterize outcomes based on achalasia subtypes, hospitalization course, pharmacological aspects, pre-procedural evaluations, as well as intra- and post-procedural data. Additionally, as NRD is an administrative database, coding errors cannot be excluded. Owing to intrinsic limitations of the NRD database, data on the type of achalasia and intraprocedural mortality were unavailable. Additionally, the sample size of POEM limited our ability to perform subgroup analyses based on the year of procedure.
In conclusion, between 2016 and 2020 in the US, POEM and LHM had similar readmission, all-cause mortality, and complication rates, which are significantly lower than that for PD. We believe that careful patient selection for the management of achalasia is key to ensuring the best clinical outcomes and preventing adverse events.
Fig. 1.
Comparison of periprocedural adverse events among pneumatic dilation, peroral endoscopic myotomy (POEM), and laparoscopic Heller myotomy.
ce-2024-103f1.jpg
Table 1.
Baseline hospitalization characteristics, comparison of 30-day readmission rates, and requirement of additional procedures on readmission for achalasia patients that underwent POEM, LHM, and PD in the United States between 2016–2020
POEM (n=2,343) LHM (n=11,345) PD (n=2,922) p-value
Mean age (range) 58.64 (57.58–59.71) 56.43 (55.93–56.93) 68.39 (67.35–69.44)
Sex
 Male 1,148 (49.0) 5,803 (51.2) 1,369 (46.9) 0.011
 Female 1,196 (51.0) 5,542 (48.8) 1,552 (53.1)
Charlson comorbidity index
 0 1,254 (53.5) 6,830 (60.2) 949 (32.5) <0.001
 1 593 (25.3) 2,586 (22.8) 702 (24.0)
 2 246 (10.5) 1,035 (9.1) 524 (17.9)
 3 or more 250 (10.7) 895 (7.9) 747 (25.6)
Comorbidities
 Congestive heart failure 123 (5.2) 434 (3.8) 491 (16.8) <0.001
 Renal disease 163 (7.0) 586 (5.2) 497 (17.0) <0.001
 Chronic obstructive pulmonary disease 244 (10.4) 989 (8.7) 542 (18.5) <0.001
 Diabetes mellitus 431 (18.4) 1,729 (15.2) 697 (23.9) <0.001
 Morbid obesity 122 (5.2) 666 (5.9) 153 (5.2) 0.505
 Smoking 228 (9.7) 1,238 (10.9) 359 (12.3) 0.147
 Malnutrition 267 (11.4) 779 (6.9) 622 (21.3) <0.001
Hospital location
 Metropolitan 2,337 (99.7) 11,085 (97.7) 2,781 (95.2) <0.001
 Micropolitan 6 (0.3) 227 (2.0) 110 (3.8)
 Non-urban 0 (0) 33 (0.3) 31 (1.1)
Hospital teaching status
 Metropolitan non-teaching 54 (2.3) 1,059 (9.3) 588 (20.1) <0.001
 Metropolitan teaching 2,284 (97.5) 10,026 (88.4) 2,192 (75.0)
 Micropolitan 6 (0.3) 260 (2.3) 141 (4.8)
Hospital Size
 Small 122 (5.2) 981 (8.6) 431 (14.8) <0.001
 Medium 225 (9.6) 2,076 (18.3) 642 (22.0)
 Large 1,997 (85.2) 8,289 (73.1) 1,848 (63.2)
Insurance
 Medicare 1,081 (46.1) 4,804 (42.3) 2,004 (68.6) <0.001
 Medicaid 242 (10.3) 1,240 (10.9) 293 (10.0)
 Private insurance 884 (37.7) 4,607 (40.6) 456 (15.6)
 Self-pay 48 (2.0) 245 (2.2) 93 (3.2)
Median household income
 Quartile 1 483 (20.6) 2,849 (25.1) 927 (31.7) <0.001
 Quartile 2 538 (23.0) 3,108 (27.4) 791 (27.1)
 Quartile 3 577 (24.6) 3,013 (26.6) 666 (22.8)
 Quartile 4 716 (30.6) 2,206 (19.4) 494 (16.9)
Disposition
 Home 2,114 (90.2) 10,402 (91.7) 1,879 (64.3) <0.001
 Short-term care facility 7 (0.3) 10 (0.1) 23 (0.8)
 Senior nursing facility 68 (2.9) 297 (2.6) 489 (16.7)
 Home health care 142 (6.1) 600 (5.3) 472 (16.2)
 Discharge against medical advice 6 (0.3) 11 (0.1) 26 (0.9)
Repeat procedure at readmission
 POEM 0 (0) 0 (0) 1 (0)
 LHM 3 (0.1) 2 (0) 26 (0.9)
 PD 3 (0.1) 13 (0) 30 (1.0)
Comparison of 30-day readmission rates
 POEM 97 (4.1)a) Reference
 LHM 405 (17.3)a) 0.84 (0.61–1.15) 0.289
 PD 357 (15.2)a) 2.48 (1.72–3.58) <0.001

Values are presented as number (%) or adjusted odds ratio (95% confidence interval) unless otherwise indicated.

POEM, peroral endoscopic myotomy; LHM, laparoscopic Heller myotomy; PD, pneumatic dilation.

a)30-Day readmission rate.

Table 2.
Outcomes for achalasia patients that underwent POEM, LHM, and PD in the United States between 2016–2020
Outcome POEM (n=2,343) LHM (n=11,345)a)/PD (n=2,922)b) OR (95% CI) p-value
Esophageal perforation 27 (0.68) 125 (1.05)a) 1.06 (0.55–2.04) 0.845
Puncture or laceration 36 (1.45) 203 (1.73)a) 1.21 (0.65–2.23) 0.54
Hemorrhage 57 (2.19) 276 (2.29)a) 1.21 (0.69–2.11) 0.496
Blood transfusion 17 (0.7) 56 (0.49)a) 0.87 (0.41–1.86) 0.727
Sepsis 25 (0.94) 74 (0.64)a) 0.81 (0.40–1.65) 0.577
Intensive care unit care 42 (1.52) 152 (1.25)a) 0.94 (0.53–1.67) 0.855
Mortality 5 (0.2) 19 (0.16)a) 1.40 (0.20–9.83) 0.733
Mean length of stay (day) 3.2 2.99a) 0.024 (–0.32 to 0.37) 0.889
Total hospitalization charges (USD) 67,153 68,486a) 1,882 (–6,814 to 1,0578) 0.671
Esophageal perforation 27 (0.68) 33 (1.13)b) 2.45 (0.89–6.69) 0.08
Puncture or laceration 36 (1.45) 39 (1.34)b) 1.34 (0.61–2.92) 0.461
Hemorrhage 57 (2.19) 128 (4.38)b) 1.84 (0.92–3.68) 0.081
Blood transfusion 17 (0.7) 66 (2.27)b) 2.16 (1.02–4.55) 0.043
Sepsis 25 (0.94) 63 (2.15)b) 1.67 (0.75–3.72) 0.201
Intensive care unit care 42 (1.52) 113 (3.86)b) 2.12 (1.12–4.02) 0.02
Mortality 5 (0.2) 31 (1.08)b) 1.71 (0.34–8.61) 0.514
Mean length of stay (day) 3.2 6.43b) 2.07 (1.54–2.6) <0.001
Total hospitalization charges (USD) 67,153 72,242b) –595 (–11,213 to 10,021) 0.912

Values are presented as number (%).

POEM, peroral endoscopic myotomy; LHM, laparoscopic Heller myotomy; PD, pneumatic dilation; OR, odds ratio; CI, confidence interval.

a)LHM, b)PD.

Table 3.
Most commonly identified reasons for 30-day readmission in achalasia patients undergoing POEM, LHM, and PD in the United States, 2016–2020
Cause of readmission Proportion of readmissions (%)
POEM
 Gastrointestinal hemorrhage 9.49
 Unspecified post-procedural complication of the digestive system 7.84
 Achalasia 7.48
 Vomiting with dehydration and acute kidney injury 6.91
 Sepsis 5.87
LHM
 Achalasia 14.76
 Vomiting with dehydration and acute kidney injury 9.59
 Sepsis 5.80
 Abdominal pain 5.54
 Aspiration pneumonia 5.44
PD
 Achalasia 37.03
 Aspiration pneumonia 8.78
 Sepsis 6.67
 Vomiting with dehydration and acute kidney injury 5.33
 Esophageal ulcer and bleeding 4.01

POEM, peroral endoscopic myotomy; LHM, laparoscopic Heller myotomy; PD, pneumatic dilation.

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        Comparison of peroral endoscopic myotomy, laparoscopic Heller myotomy, and pneumatic dilation for patients with achalasia: a United States national experience
        Clin Endosc. 2025;58(1):153-157.   Published online December 24, 2024
        DOI: https://doi.org/10.5946/ce.2024.103
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      Comparison of peroral endoscopic myotomy, laparoscopic Heller myotomy, and pneumatic dilation for patients with achalasia: a United States national experience
      Image
      Fig. 1. Comparison of periprocedural adverse events among pneumatic dilation, peroral endoscopic myotomy (POEM), and laparoscopic Heller myotomy.

      Fig. 1.

      Comparison of peroral endoscopic myotomy, laparoscopic Heller myotomy, and pneumatic dilation for patients with achalasia: a United States national experience
      POEM (n=2,343) LHM (n=11,345) PD (n=2,922) p-value
      Mean age (range) 58.64 (57.58–59.71) 56.43 (55.93–56.93) 68.39 (67.35–69.44)
      Sex
       Male 1,148 (49.0) 5,803 (51.2) 1,369 (46.9) 0.011
       Female 1,196 (51.0) 5,542 (48.8) 1,552 (53.1)
      Charlson comorbidity index
       0 1,254 (53.5) 6,830 (60.2) 949 (32.5) <0.001
       1 593 (25.3) 2,586 (22.8) 702 (24.0)
       2 246 (10.5) 1,035 (9.1) 524 (17.9)
       3 or more 250 (10.7) 895 (7.9) 747 (25.6)
      Comorbidities
       Congestive heart failure 123 (5.2) 434 (3.8) 491 (16.8) <0.001
       Renal disease 163 (7.0) 586 (5.2) 497 (17.0) <0.001
       Chronic obstructive pulmonary disease 244 (10.4) 989 (8.7) 542 (18.5) <0.001
       Diabetes mellitus 431 (18.4) 1,729 (15.2) 697 (23.9) <0.001
       Morbid obesity 122 (5.2) 666 (5.9) 153 (5.2) 0.505
       Smoking 228 (9.7) 1,238 (10.9) 359 (12.3) 0.147
       Malnutrition 267 (11.4) 779 (6.9) 622 (21.3) <0.001
      Hospital location
       Metropolitan 2,337 (99.7) 11,085 (97.7) 2,781 (95.2) <0.001
       Micropolitan 6 (0.3) 227 (2.0) 110 (3.8)
       Non-urban 0 (0) 33 (0.3) 31 (1.1)
      Hospital teaching status
       Metropolitan non-teaching 54 (2.3) 1,059 (9.3) 588 (20.1) <0.001
       Metropolitan teaching 2,284 (97.5) 10,026 (88.4) 2,192 (75.0)
       Micropolitan 6 (0.3) 260 (2.3) 141 (4.8)
      Hospital Size
       Small 122 (5.2) 981 (8.6) 431 (14.8) <0.001
       Medium 225 (9.6) 2,076 (18.3) 642 (22.0)
       Large 1,997 (85.2) 8,289 (73.1) 1,848 (63.2)
      Insurance
       Medicare 1,081 (46.1) 4,804 (42.3) 2,004 (68.6) <0.001
       Medicaid 242 (10.3) 1,240 (10.9) 293 (10.0)
       Private insurance 884 (37.7) 4,607 (40.6) 456 (15.6)
       Self-pay 48 (2.0) 245 (2.2) 93 (3.2)
      Median household income
       Quartile 1 483 (20.6) 2,849 (25.1) 927 (31.7) <0.001
       Quartile 2 538 (23.0) 3,108 (27.4) 791 (27.1)
       Quartile 3 577 (24.6) 3,013 (26.6) 666 (22.8)
       Quartile 4 716 (30.6) 2,206 (19.4) 494 (16.9)
      Disposition
       Home 2,114 (90.2) 10,402 (91.7) 1,879 (64.3) <0.001
       Short-term care facility 7 (0.3) 10 (0.1) 23 (0.8)
       Senior nursing facility 68 (2.9) 297 (2.6) 489 (16.7)
       Home health care 142 (6.1) 600 (5.3) 472 (16.2)
       Discharge against medical advice 6 (0.3) 11 (0.1) 26 (0.9)
      Repeat procedure at readmission
       POEM 0 (0) 0 (0) 1 (0)
       LHM 3 (0.1) 2 (0) 26 (0.9)
       PD 3 (0.1) 13 (0) 30 (1.0)
      Comparison of 30-day readmission rates
       POEM 97 (4.1)a) Reference
       LHM 405 (17.3)a) 0.84 (0.61–1.15) 0.289
       PD 357 (15.2)a) 2.48 (1.72–3.58) <0.001
      Outcome POEM (n=2,343) LHM (n=11,345)a)/PD (n=2,922)b) OR (95% CI) p-value
      Esophageal perforation 27 (0.68) 125 (1.05)a) 1.06 (0.55–2.04) 0.845
      Puncture or laceration 36 (1.45) 203 (1.73)a) 1.21 (0.65–2.23) 0.54
      Hemorrhage 57 (2.19) 276 (2.29)a) 1.21 (0.69–2.11) 0.496
      Blood transfusion 17 (0.7) 56 (0.49)a) 0.87 (0.41–1.86) 0.727
      Sepsis 25 (0.94) 74 (0.64)a) 0.81 (0.40–1.65) 0.577
      Intensive care unit care 42 (1.52) 152 (1.25)a) 0.94 (0.53–1.67) 0.855
      Mortality 5 (0.2) 19 (0.16)a) 1.40 (0.20–9.83) 0.733
      Mean length of stay (day) 3.2 2.99a) 0.024 (–0.32 to 0.37) 0.889
      Total hospitalization charges (USD) 67,153 68,486a) 1,882 (–6,814 to 1,0578) 0.671
      Esophageal perforation 27 (0.68) 33 (1.13)b) 2.45 (0.89–6.69) 0.08
      Puncture or laceration 36 (1.45) 39 (1.34)b) 1.34 (0.61–2.92) 0.461
      Hemorrhage 57 (2.19) 128 (4.38)b) 1.84 (0.92–3.68) 0.081
      Blood transfusion 17 (0.7) 66 (2.27)b) 2.16 (1.02–4.55) 0.043
      Sepsis 25 (0.94) 63 (2.15)b) 1.67 (0.75–3.72) 0.201
      Intensive care unit care 42 (1.52) 113 (3.86)b) 2.12 (1.12–4.02) 0.02
      Mortality 5 (0.2) 31 (1.08)b) 1.71 (0.34–8.61) 0.514
      Mean length of stay (day) 3.2 6.43b) 2.07 (1.54–2.6) <0.001
      Total hospitalization charges (USD) 67,153 72,242b) –595 (–11,213 to 10,021) 0.912
      Cause of readmission Proportion of readmissions (%)
      POEM
       Gastrointestinal hemorrhage 9.49
       Unspecified post-procedural complication of the digestive system 7.84
       Achalasia 7.48
       Vomiting with dehydration and acute kidney injury 6.91
       Sepsis 5.87
      LHM
       Achalasia 14.76
       Vomiting with dehydration and acute kidney injury 9.59
       Sepsis 5.80
       Abdominal pain 5.54
       Aspiration pneumonia 5.44
      PD
       Achalasia 37.03
       Aspiration pneumonia 8.78
       Sepsis 6.67
       Vomiting with dehydration and acute kidney injury 5.33
       Esophageal ulcer and bleeding 4.01
      Table 1. Baseline hospitalization characteristics, comparison of 30-day readmission rates, and requirement of additional procedures on readmission for achalasia patients that underwent POEM, LHM, and PD in the United States between 2016–2020

      Values are presented as number (%) or adjusted odds ratio (95% confidence interval) unless otherwise indicated.

      POEM, peroral endoscopic myotomy; LHM, laparoscopic Heller myotomy; PD, pneumatic dilation.

      30-Day readmission rate.

      Table 2. Outcomes for achalasia patients that underwent POEM, LHM, and PD in the United States between 2016–2020

      Values are presented as number (%).

      POEM, peroral endoscopic myotomy; LHM, laparoscopic Heller myotomy; PD, pneumatic dilation; OR, odds ratio; CI, confidence interval.

      a)LHM, b)PD.

      Table 3. Most commonly identified reasons for 30-day readmission in achalasia patients undergoing POEM, LHM, and PD in the United States, 2016–2020

      POEM, peroral endoscopic myotomy; LHM, laparoscopic Heller myotomy; PD, pneumatic dilation.

      Table 1.

      Table 2.

      Table 3.

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