ACHALASIA hospitalizations in the United States increasingly feature POEM adoption alongside rising patient complexity.
A Decade of Rising POEM In Achalasia Hospitalizations
This retrospective trend study analyzed 63,420 weighted achalasia hospitalizations from 2011 to 2022 using the National Inpatient Sample and demonstrated that the dominant procedural signal over this period was declining laparoscopic Heller myotomy use accompanied by a steady rise in per oral endoscopic myotomy. The proportion receiving POEM was 5.8% in 2016 and reached 10.3% in 2022 and adjusted modelling demonstrated significantly higher odds of POEM in the contemporary period. The decline in laparoscopic Heller myotomy was robust with a negative annual percentage change while esophagectomy also decreased. Pneumatic dilation was measured in the procedural mix though the most clinically material pivot concerned the relative gain of POEM within inpatient achalasia management.
Costs Increased and Case Mix Changed
Annual hospitalization costs increased by more than 3% per year while median length of stay was stable. Although unadjusted mortality rose over time adjusted analyses suggest that the apparent mortality signal primarily reflected worsening comorbidity profiles rather than harm from procedural selection. The study reported increased odds of respiratory complications in the contemporary period and this aligns with clinically recognizable patterns in older multimorbid inpatient cohorts. Taken together these data highlight that continued POEM adoption alone is unlikely to reverse inpatient cost inflation if case mix continues to deteriorate.
Clinical Implications for Future Achalasia Management
Achievement of outcome stabilization may rely on earlier referral routes and routine POEM access for appropriate patients before deterioration to more complex phenotypes needing inpatient care. Implementation pathways that foreground early intervention can potentially minimize respiratory complications and other decompensation signals. These decade level utilization signals illustrate how procedural mix evolution and case mix acuity intersect and may shape future motility service configurations across inpatient and ambulatory settings.
Reference: Goyal RM et al. A Decade of Change: National Trends in Management and Outcomes of Achalasia Hospitalizations in the United States. Neurogastroenterol Motil. 2025:e70202.
