Anesthesia for Per-oral endoscopic myotomy (POEM) – not so poetic!

Abstract

Peroral endoscopic myotomy (POEM) is a promising natural orifice transluminal endoscopic procedure for the treatment of esophageal motility disorders, with similar effectiveness as of Heller myotomy. It is performed under general anesthesia in endoscopy suite. Creation of submucosal tunnel in the esophageal wall is a key component. The continuous insufflation of CO 2 inadvertently tracks into surrounding tissues and leads to capno mediastinum, capno thorax, capno peritoneum, and subcutaneous emphysema. Thus, the challenges, for an anesthesiologist are not only providing remote location anesthesia, increased risk of aspiration during induction, but also early detection of these complications and specific emergency management. Though a therapeutic innovation, POEM remains an interdisciplinary challenge with no specific anesthesia care algorithms and evidence-based recommendations. The purpose of this review is to outline the anesthesia and periprocedural practices based on existing evidence.

Anaesthetic management and associated complications of per-oral endoscopic myotomy (POEM) procedure in a patient with achalasia cardia type II: A case report

“…The continuous insufflation of CO2 is required for submucosal tunnelling which inadvertently tracks into surrounding tissues and leads to capnomediastinum, capnothorax, capnoperitoneum, and subcutaneous emphysema. Thus, the challenges, for an anaesthesiologist are not only providing remote location anaesthesia, increased risk of aspiration during induction, but also early detection of these complications and specific emergency management [2] .…”