Impact of the COVID‐19 pandemic on high‐resolution manometry and peroral endoscopic myotomy for esophageal motility disorder in Japan

Abstract

Aim To elucidate the impact of the coronavirus disease 2019 (COVID‐19) on the practice of high‐resolution manometry (HRM) and peroral endoscopic myotomy (POEM) in Japan. Methods We utilized a large‐scale database involving 14 high‐volume centers in Japan to investigate changes in the numbers of HRM and POEM procedures performed and outcomes of POEM between 2019 and 2020. A questionnaire survey was also conducted to analyze pandemic‐associated changes in the HRM and POEM protocols. Results Compared to that in 2019, the number of HRM and POEM procedures decreased by 17.2% (1587–1314) and 20.9% (630–498), respectively. These declines were prominent during the state of emergency from April to May 2020, particularly in pandemic areas. HRM and POEM in nonpandemic areas were relatively unaffected. From 2019 to 2020, there was a 0.4% (254–248) decrease in POEM cases within the prefecture, but the number outside the prefecture decreased by 33.6% (372–247). During the pandemic, the safety and efficacy of POEM were maintained. The implementation of personal protective equipment (PPE) measures varied among facilities, and PPE for POEM was relatively insufficient compared to that for HRM. Conclusion The COVID‐19 pandemic influenced HRM and POEM practices in Japan. It is necessary to establish a sufficient system for HRM and POEM in each hospital as well as countrywide to overcome the effects of the pandemic.

Impact of the coronavirus disease pandemic on peroral endoscopic myotomy and high‐resolution manometry activity in Japan

“…Ominami et al 6 . analyzed the impact of COVID‐19 on high‐resolution manometry (HRM) and POEM for esophageal motility disorders (EMDs), including achalasia.…”

“…Given the major pulmonary involvement of COVID‐19, special attention should be paid to aspiration pneumonia, which is a potentially significant comorbidity of achalasia. Fortunately, no patients were confirmed to have COVID‐19 during the Japanese multicenter study period 6 …”

“…4 Using the UK National Endoscopy Database, Rutter et al 5 analyzed the impact of the COVID-19 pandemic on endoscopic services, reporting that activity during the COVID-affected period had reduced to 12% of the pre-COVID level, and only 5% during the lowest period. Conversely, a recent detailed nominal analysis of the pandemic's impact on nonurgent endoscopic treatments-including peroral endoscopic myotomy (POEM)-may be informative and facilitate preparation for the upcoming resurge.Ominami et al 6 analyzed the impact of COVID-19 on high-resolution manometry (HRM) and POEM for esophageal motility disorders (EMDs), including achalasia. The study was conducted across 14 Japanese high-volume centers with expertise in POEM, using a questionnaire survey.…”

“…Ominami et al 6 analyzed the impact of COVID-19 on high-resolution manometry (HRM) and POEM for esophageal motility disorders (EMDs), including achalasia. The study was conducted across 14 Japanese high-volume centers with expertise in POEM, using a questionnaire survey.…”

“…Fortunately, no patients were confirmed to have COVID-19 during the Japanese multicenter study period. 6 Meanwhile, an Italian COVID-19 case report described worsening thoracic pain due to intractable type II achalasia in elderly women with obesity who had already undergone pneumatic dilatation and Heller-Dor myotomy. 7 POEM, a less invasive and highly successful endoscopic intervention, is thus recommended in such cases.…”