Early adverse events of per-oral endoscopic myotomy

Werner, Yuki B.; Renteln, Daniel von; Noder, Tania; Schachschal, Guido; Denzer, Ulrike W.; Groth, Stefan; Nast, J; Kersten, Jan Felix; Petzoldt, Martin; Adam, Gerhard; Mann, Oliver; Repici, Alessandro; Hassan, Cesare; Rösch, Thomas

doi:10.1016/j.gie.2016.08.033

Cited by 79 publications

(55 citation statements)

References 54 publications

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“…Capno-/pneumoperitoneum (30.6 %), capno-/pneumothorax (11.0 %) and subcuta-neous emphysema (36.1 %) were frequent; nevertheless, major adverse events such as mediastinal leakage requiring endoscopic or surgical treatment were rare (0.3 %) [67]. A subsequent retrospective cohort that was focused exclusively on POEM-related adverse effects confirmed these results [68].…”

Section: Recommendationmentioning

confidence: 77%

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

et al. 2020

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Summary of Recommendations 1 ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied. 3 ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan. 4 ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed. 5 ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.

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Section: Recommendationmentioning

confidence: 77%

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

et al. 2020

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“…AEs commonly associated with POEM include insufflation-related problems, bleeding (intraprocedural or delayed) and mucosal perforations 4 21 22 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of anterior myotomy versus posterior myotomy during POEM: a randomized pilot study

et al. 2018

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Background and study aims Peroral endoscopic myotomy (POEM) can be performed via an anterior or posterior approach, depending on the operator’s preference. Data are lacking on comparative outcomes of both approaches. Patients and methods This is a pilot randomized study comparing endoscopic anterior and posterior myotomy during POEM in patients with Achalasia cardia (AC). Patients were randomized into 2 groups (n = 30 in each group); anterior myotomy group (AG) and posterior myotomy group (PG) and were followed at 1, 3 and 6 months after POEM. Results Technical success was achieved in 100 % of cases in both groups and total operative time was comparable (AG – 65 ± 17.65 minutes versus PG – 61.2 ± 16.67; P = 0.38); Mucosotomies were more frequent in AG (20 % vs 3.3 %; P = 0.02). Difference in other perioperative adverse events (AE) including insufflation-related AE and bleeding in both groups were statistically insignificant. At 1-month follow-up Eckardt score AG 0.57 ± 0.56 vs PG 0.53 ± 0.71; ( P = 0.81), mean LES pressure AG 11.93 ± 6.36 vs PG 11.77 ± 6.61; ( P = 0.59) and esophageal emptying on timed barium swallow at 5 minutes AG 1.32 ± 1.08 cm vs PG 1.29 ± 0.79 cm; ( P = 0.09) were comparable in both groups. At 3 months, Eckardt score (0.52 ± 0.59 vs 0.63 ± 0.62; P = 0.51) was similar in both groups. Incidence of esophagitis on EGD was comparable in both groups (24 % vs 33.3 %; P = 0.45), however, pH metry at 3 months showed significantly more esophageal acid exposure in posterior group (2.98 % ± 4.24 vs 13.99 % ± 14.48; P < 0.01). At 6 months clinical efficacy and LES pressures were comparable in both groups. Conclusion Anterior and posterior approaches to POEM seem to have equal efficacy. However, the occurrence of mucosotomies was higher in the anterior myotomy group and acid exposure was higher with the posterior myotomy approach during POEM.

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“…If pneumoperitoneum occurs, it should be treated with rapid needle decompression of the upper abdomen. However, some reports have concluded that while subcutaneous emphysema, mediastinal emphysema and pneumoperitoneum were common during POEM, these did not cause serious complications and no special intervention was required[ 18 , 19 ]. In the previous five reports[ 9 - 13 ], EtCO 2 increased during POEM, but no case of ventilatory impairment occurred.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management and associated complications of peroral endoscopic myotomy: A case series

Nishihara

Yoshida

Ooi

et al. 2018

WJGE

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AIMTo investigate the anesthetic management of peroral endoscopic myotomy (POEM) and its associated complications.METHODSThis study was a single-center, retrospective, observational study comprising a case series of all patients who underwent POEM in our hospital from April 2015 to November 2016. We collected data regarding patient characteristics, anesthetic methods, surgical factors, and complications using an electronic chart.RESULTSThere were 86 patients who underwent POEM in our hospital during the study period. Preoperatively, patients were maintained on a low residue diet for 48 h prior to the procedure. They were fasted of solids for 24 h before surgery. There was one case of aspiration (1.2%). During POEM, patients were positioned supine with the upper abdomen covered by a clear drape so that pneumoperitoneum could be timeously identified. In three cases, the peak airway pressure exceeded 35 cmH2O during volume controlled ventilation with tidal volumes of 6-8 mL/kg and subsequent impairment of ventilation. These cases had been diagnosed with spastic esophageal disorders (SEDs) and the length of the muscular incision on the esophageal side was longer than normal.CONCLUSIONIn the anesthetic management of POEM, it is important to prevent aspiration during induction of anesthesia and to identify and treat complications associated with CO2 insufflation.

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Early adverse events of per-oral endoscopic myotomy

Cited by 79 publications

References 54 publications

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Outcomes of anterior myotomy versus posterior myotomy during POEM: a randomized pilot study

Anesthetic management and associated complications of peroral endoscopic myotomy: A case series

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