Endoscopy 2019; 51(04): S82-S83
DOI: 10.1055/s-0039-1681412
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: Motility 1 Forum
Georg Thieme Verlag KG Stuttgart · New York

PERIPROCEDURAL SAFETY PROFILE OF PERORAL ENDOSCOPIC MYOTOMY (POEM)

D Drazilova
1   Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
,
Z Vackova
1   Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
,
T Hucl
1   Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
,
P Stirand
1   Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
,
E Kieslichová
2   Department of Anesthesiology and Intensive Care, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
,
R Janousek
3   Radiodiagnostic and Interventional Radiology Department, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
,
J Spicak
1   Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
,
J Martinek
1   Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

POEM has become a standard treatment for achalasia due to its efficacy and safety. Nevertheless, POEM remains an invasive intervention carrying risk of complications. The aim was to assess the perioperative complications of patients undergoing POEM at our institution.

Methods:

We retrospectively reviewed the documentation of patients who underwent POEM 12/2012 – 5/2018 and searched for periprocedural complications. The Clavien-Dindo (C-D) classification was used to assess the severity of adverse events.

Results:

243 POEM procedures in 231 patients were performed. 50/243 procedures (20.6%) passed uneventfully, in 193 procedures (79.4%) some adverse events occurred. The distribution in C-D categories was as follows: I- 180 (180/193, 93.3%), II- 2 (1%), IIIa – 3 (1,6%), IVa – 6 (3.1%), IVb – 1 (0.5%) and V – 1 (0.5%). The periprocedural adverse events were: subcutaneus emphysema 79/243 (32.5%), capnoperitoneum puncture 141/243 (58%), allergic reaction to antibiotics 2/243 (0.8%) and anaesthesia-related complications in 14/243 (5.8%) patients. Postoperatively, 158/243 patients (65%) experienced pain requiring analgesics, 20/243 patients (8.2%) had fever. In 5/243 patients (2%) the postoperative esophagogram revealed leakage. Severe adverse events (CD IV-V) occurred in 8/243 (3.3%) patients: 3x (1.2%) pneumonia, 2x (0.8%) pneumothorax, 1x (0.4%) fluidothorax, 1x (0,4%) lost of taste and smell, 1 periprocedural death (0.4%) due to sudden cardiac arrest. Prolonged (≥4 days) hospitalization was required in 25 (17.4%) patients.

In 172 patients ASA score was available: I- 44/172 (25.6%), II- 90 (52.3%), III- 36 (21%), IV- 2 (1.2%). From patients with ASA I, II, III no adverse events occurred in 18.2%, 17.8% and 16.7%. Serious complications occurred in patients with ASA I, II, III in 0%, 5.6% and 13.9%.

Conclusions:

Mild POEM-related adverse events (C-D I) are rather common. Although being rare, severe complications, and even fatal, may still occur. Risk of severe complications seems to rise with higher ASA score.