Impact of hiatal hernia on periprocedural outcomes following peroral endoscopic myotomy: a nationwide retrospective study.

BACKGROUND AND AIMS: The influence of hiatal hernia (HH) presence on peroral endoscopic myotomy (POEM) outcomes remains unclear. This study aimed to compare post-POEM outcomes between patients with and without HH.

METHODS

Using the Nationwide Inpatient Sample from 2016 through 2022, we identified 6572 patients undergoing POEM for achalasia or non-achalasia spastic disorders. One-to-one propensity score matching was performed to compare adverse events, defined as any adverse event associated with an extended length of stay (> 3 days), reintervention, 30-day mortality, and length of stay between the groups.

RESULTS

In the propensity score-matched analysis involving 1276 pairs, the HH group had significantly higher rates of adverse events (8.4% vs 6.3%; p = 0.04) and reintervention (7.2% vs 5.3%; p = 0.04) compared to the non-HH group. The most common adverse events were infections, such as peritonitis and mediastinitis (4.9% vs 3.3%; p = 0.04). A longer length of stay (median: 4 vs 3 days; p < 0.01) was observed in the HH group. No significant difference in 30-day mortality was noted between the groups. On logistic regression analysis, HH (OR 1.36; 95% CI 1.06-1.68) and achalasia (vs. non-achalasia spastic disorders; OR 1.54; 95% CI 1.17-2.02) were associated with adverse events.

CONCLUSION

The risk of adverse events and reintervention were higher in the HH group. These findings highlight the need for tailored management in POEM for HH cases. Further prospective studies are required to confirm these results.