Economic impact and utilization trends of peroral endoscopic myotomy and endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM) are minimally invasive therapeutic procedures that have transformed the management of select gastrointestinal disorders. However, their financial impact remains poorly understood, with persistent under-reimbursement and limited data on billing and downstream revenue. This study examines financial data from a U.S. tertiary care center between 2018 and 2024 to evaluate revenue sources and reimbursement trends.

This is a single-center, retrospective study of 825 patients who underwent ESD or esophageal POEM as identified by Current Procedural Terminology codes 43999, 43497, 43499, 45399, and 45999 at a tertiary care center in the United States between January 2018 and December 2024. We analyzed demographic data, physician and hospital charges, and reimbursements from initial visits to postprocedure care to quantify revenue. We also categorized patients whose initial visit marked their first engagement within our health care network. Financial data were analyzed descriptively.

ESD and POEM procedures generated substantial charges ($73.5M) and reimbursements ($15.7M) through procedure costs plus downstream health care services. In addition, 349 patients (42%) who were new to the network at the time of their procedure accounted for $28.5M in charges and $5.8M in reimbursements.

Although ESD and POEM may seem difficult to scale because of low reimbursement rates, this study demonstrates their substantial economic impact through significant downstream charges and reimbursements. These findings highlight the need to balance delivering accessible, affordable care with ensuring the financial sustainability of hospitals, especially as health care institutions face rising costs that are not always offset by reimbursements.