Anesthetic considerations for patients with esophageal achalasia undergoing peroral endoscopic myotomy: a retrospective case series review

Löser, Benjamin; Werner, Yuki B.; Punke, Mark A.; Saugel, Bernd; Haas, Sebastian; Reuter, Daniel A.; Mann, Oliver; Duprée, Anna; Schachschal, Guido; Rösch, Thomas; Petzoldt, Martin

doi:10.1007/s12630-017-0820-5

Cited by 19 publications

(31 citation statements)

References 27 publications

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“…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. Our report is the first one describing ventilatory impairment during POEM.…”

Section: Discussionmentioning

confidence: 83%

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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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Section: Discussionmentioning

confidence: 83%

“…Until now, there have been five reports of the anesthetic management of POEM[ 9 - 13 ]. These are summarized in Table 4 .…”

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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“…In this case, anesthesia induced normally could lead to aspiration. To prevent aspiration, it is recommended that rapid induction with cricoid pressure be used and extra caution be taken to prevent regurgitation from the esophagus into the oropharynx …”

Section: Clinical Questions and Statementsmentioning

confidence: 99%

Clinical practice guidelines for peroral endoscopic myotomy

Inoue

Shiwaku

Iwakiri

et al. 2018

Digestive Endoscopy

127

159

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Peroral endoscopic myotomy (POEM) is a novel clinical technique developed in Japan used to treat esophageal achalasia and esophageal motility disorders. This technique has been rapidly accepted and widely disseminated throughout our clinical practice because of its low invasiveness, technical novelty, and high efficacy. Since the advent of POEM, there have been no clinical guidelines that clearly indicated its standard of care, and these guidelines have been anticipated both nationally and internationally by clinicians who engage in POEM practice. In 2017, to meet these needs, the Japan Gastroenterological Endoscopy Society (JGES) launched the guideline committee for POEM. Based on the guideline development process proposed by the Medical Information Network Distribution Service (MINDS), the guideline committee initially created research questions on POEM and conducted a systematic review and meta-analysis on each topic. The clinical research extracted from databases for these clinical questions and the systematic review mainly comprised a few retrospective studies with a small number of participants and short trial periods; hence, the strength of the evidence and recommendations derived from these results was low. Throughout this process, the guideline committee met thrice: once on May 13, 2017, and again on September 17, 2017, to formulate the draft. A consensus meeting was then held on January 14, 2018, in Tokyo to establish the guideline statements and finalize the recommendations using the modified Delphi method. This manuscript presents clinical guidelines regarding current standards of practice and recommendations in terms of the nine chief topics in POEM.

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“…Preoperative fasting is usually 8 h in principle, but recently, it is recommended to allow 6 h for light meal and 2 h for clear liquid recently.11 However, no guideline exists for anesthesia management and pre-fasting time for POEM to date. In a recent case series on POEM anesthesia management, fasting times were reported to range from 8 h to 48 h [12-15]. Whether esophagogastroduodenoscopy (EGD) should be performed prophylactically to remove food that may remain in the esophagus is controversial.…”

Section: Fastingmentioning

confidence: 99%

“…Whether esophagogastroduodenoscopy (EGD) should be performed prophylactically to remove food that may remain in the esophagus is controversial. Prophylactic EGD was performed in two case series [12,15], but not in the other two series [13,14]. One case series without prophylactic EGDs recognized the need for it [14], and the other claimed that prophylactic EGD itself was not necessary as it increased the patient’s risk of aspiration [13].…”

Section: Fastingmentioning

confidence: 99%

Anesthetic Consideration for Peroral Endoscopic Myotomy

Bang

Park

2019

Clin Endosc

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A recent achalasia guideline suggests that peroral endoscopic myotomy (POEM) is a safe option for achalasia that is as effective as Heller myotomy. It is recommended that POEM should be performed under general anesthesia. The incidence of adverse events such as bleeding, perforation, and carbon dioxide insufflation-related complications was lower in POEM under endotracheal general anesthesia than in POEM under sedation. Subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and accompanying hemodynamic instability can be caused by carbon dioxide insufflation. Treatment of possible physiological changes and adverse events during the POEM procedure from the point of view of anesthesiologists may give endoscopists a new perspective on improving patient safety. The territory of therapeutic endoscopy can be expanded through cooperation with other departments, including anesthesia services. Efforts to understand different perspectives will certainly help not only secure patient safety but also expand the area of treatment.

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Anesthetic considerations for patients with esophageal achalasia undergoing peroral endoscopic myotomy: a retrospective case series review

Cited by 19 publications

References 27 publications

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

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

Clinical practice guidelines for peroral endoscopic myotomy

Anesthetic Consideration for Peroral Endoscopic Myotomy

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