Novel preprocedural preparation before POEM-Simplified

Aims To devise a simple yet effective method for preprocedural preparation for POEM

Methods We have devised a scoring system depending on the status of esophageal mucosa, presence of fluid/froth and severity of candidial infection on the initial endoscopy.Grade I – clean esophagusGrade II – presence of fluid/froth+crumpled normal mucosaGrade III- fluid/froth+intermittent esophageal candidiasisGrade IV- fluid/froth+severe candidiasisGrade V- extensive food residue+candidiasisA comparative analysis of 100 patients with Achalasia cardia. Group – A (n=50) – conventional preparation1. Clear liquids for 48 hours2. NBM for 24 hours prior to POEM3. Thorough wash with saline on the day before POEMGroup – B (n=50) – novel method1. patients are kept on warm water and limca “carbonated drink” only2. NBM for 6 hours prior to POEM3. No thorough wash

Results No difference was found in group I to III in both the groups for luminal clearance. But Group-B was superior in terms of shorter stay, less cost (10000 INR less) and more compliance. All the patients of Grade-V and 2 of Grade-IV in group-A required additional wash prior to POEM.Group-B patients had clear lumen even in grade-IV and V. Group-B patients had benefit of less exposure to anesthetic drugs as they undergo only one procedure compared to group-A where they undergo twice. [1] [2]

Conclusions our protocol for preparation before POEM is simple yet more cost effective, more compliant and more reliable.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Koumi A, Panos MZ.. Oesophageal food impaction in achalasia treated with Coca-Cola and nifedipine. BMJ Case Rep. 2010. 2010. bcr05.2009.1891
• 2 Ren Y, Ke M, Fang X, Zhu L, Sun X, Wang Z. et al. Response of esophagus to high and low temperatures in patients with achalasia. J Neurogastroenterol Motil 2012; 18: 391-8

Publication History

Article published online:
15 April 2024