Decision regret for patients undergoing laparoscopic Heller myotomy and peroral endoscopic myotomy

Peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) are the main endoscopic and surgical options for patients with achalasia and other motility disorders that disrupt esophagogastric outflow. This study aimed to assess and compare the rates of decision regret (DR) for patients who underwent LHM and POEM.

A prospectively maintained single-institution database was queried for all patients who underwent LHM and POEM between 2011 and 2024. The primary outcome was DR. The secondary outcome was reasons for regret. A multivariate analysis (MVA) was performed to identify the predictors of DR.

The study included 135 patients: 31 in the LHM group and 104 in the POEM group. Achalasia (84.5%) was the most common preprocedural diagnosis, followed by esophagogastric junction outflow obstruction (EGJOO; 6.7%). Of all patients, 81.5% did not endorse any DR. Patients who underwent LHM had a lower rate of DR than those who underwent POEM (6.5% vs 22.1%, respectively; P =.04). DR for patients in the POEM group was predominantly due to reflux (65.3%). Only 6.7% of patients were not sure that they would undergo the procedure again, all of whom were in the POEM group. On MVA, type 1 achalasia (95% CI, 1.58-15.00; P =.01) and EGJOO (95% CI, 1.62-35.9; P =.01) were predictors of DR but not POEM.

More than 80% of patients who underwent LHM and POEM did not exhibit DR. Patients who underwent POEM exhibited more DR than those who underwent LHM. DR was strongly linked to postprocedure reflux. In addition, DR is useful for preoperative patient counseling. POEM did not remain an independent predictor of DR on MVA.