Safety and effectiveness of peroral endoscopic myotomy in patients on antiplatelet or anticoagulant therapy: an international multicenter case-control study

Santiago, Enrique Rodríguez de; Shimamura, Yuto; Pioche, Mathieu; Eleftheriadis, Nicholas; Albéniz, Eduardo; Bechara, Robert; Chiu, Philip W.; Guarner-Argente, Carlos; Tejada, Alberto Herreros de; Uchima, Hugo; Fujiyoshi, Yusuke; Ponchon, Thierry; Gonzalez-Gete, Gonzalo; Hew, Simon; Murzi-Pulgar, Marianette; Matallana, Virginia; Parejo-Carbonell, Sofía; Estremera-Arévalo, Fermín; Moll, Frederic C.; Onimaru, Manabu; Inoue, Haruhiro

doi:10.1016/j.gie.2020.07.030

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…The incidence of postoperative bleeding for POEM has been reported to be significantly higher in patients taking antithrombotic drugs [ 33 ]. In the present study, four patients (36.4%) received antithrombotic medications, but no hemorrhage or thromboembolism was observed.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Peroral Endoscopic Myotomy for Esophageal Achalasia and Achalasia-Related Diseases in Patients Aged 75 Years and Over

et al. 2021

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Peroral endoscopic myotomy (POEM) has become a popular treatment for esophageal achalasia and other esophageal motility disorders. However, its efficacy and safety in elderly patients are unclear. To clarify that, we reviewed the medical records of patients who underwent POEM in our hospital. A total of 11 patients who underwent POEM for esophageal achalasia (n = 10) and jackhammer esophagus (n = 1) were included. Procedural success, defined as the completion of an esophageal and gastric myotomy, was 100%. Clinical success, defined as an Eckardt score of 3 or less, without the use of additional treatments at 2 months, was 100%. The median Eckardt score significantly decreased after the POEM (baseline vs. 2 months after POEM; 7 (2–8) vs. 0 (0–1), p < 0.01). In the second and third years, the cumulative treatment effect maintenance rate was 88.9%. All patients taking antithrombotic agents had safe operations with the temporary discontinuation of these agents. There were four adverse events (two pneumoperitoneum, one mucosal injury, and one pneumonia), all of which improved with fasting or antibiotics. In conclusion, POEM is an effective and safe treatment for esophageal achalasia and achalasia-related diseases in patients aged 75 years and over.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Peroral Endoscopic Myotomy for Esophageal Achalasia and Achalasia-Related Diseases in Patients Aged 75 Years and Over

et al. 2021

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“…In this study, the use of hemostatic forceps was not significantly different. However, Rodríguez de Santiago et al 8 . reported that the risk of bleeding is significantly higher in patients receiving antithrombotic therapy, and reaches 5%.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 In this study, the use of hemostatic forceps was not significantly different. However, Rodr ıguez de Santiago et al 8 reported that the risk of bleeding is significantly higher in patients receiving antithrombotic therapy, and reaches 5%. Furthermore, Bechara et al 4 reported that submucosal oozing during POEM led to prolonged procedure time because hemostatic treatment for submucosal oozing reduces the visibility of the tissue planes.…”

Section: Discussionmentioning

confidence: 99%

“…Challenging cases of POEM were defined as cases with any of the following features: (i) procedure time ≥90 min; (ii) mucosal perforation; (iii) pneumothorax; and (iv) major bleeding. 5,8 The procedure time was the time from the injection for the creation of the entry to the end of closing the entry. Pneumothorax was defined as collapsed lung on X-ray.…”

Section: Definition Of Challenging Casesmentioning

confidence: 99%

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Risk‐scoring system for predicting challenging cases of peroral endoscopic myotomy

Nakai

Abe

Tanaka

et al. 2023

Digestive Endoscopy

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ObjectivesPeroral endoscopic myotomy (POEM) is an effective treatment for esophageal motility disorders including achalasia and its variants. However, some surgeons have encountered challenging cases. This study aimed to develop a risk‐scoring system to predict challenging cases of POEM.MethodsConsecutive patients who underwent POEM between April 2015 and March 2020 at our hospital were included in this single‐center retrospective study. Challenging cases of POEM were defined as patients with any of the following: (i) procedure time ≥90 min; (ii) mucosal perforation; (iii) pneumothorax; and (iv) major bleeding. A risk‐scoring system for predicting challenging cases was developed based on multivariate logistic regression and internal validation was performed using the bootstrap method. Clinical usefulness was evaluated using a decision curve analysis.ResultsOf the 467 patients, 59 (12.6%) had challenging POEM. A risk‐scoring system consisted of four variables: duration of symptoms ≥5 years (assigned score, 1 point), antithrombotics use (1 point), manometric diagnosis of achalasia variants (2 points), and dilation grade 3 (2 points). Our scoring system showed satisfactory discrimination (area under the receiver operating characteristic curve, 0.69; 95% confidence interval [CI] 0.61–0.77) and calibration (slope, 0.99; 95% CI 0.65–1.35). The decision curve analysis demonstrated its clinical usefulness.ConclusionsWe established a risk‐scoring system to predict challenging cases of POEM. This scoring system may aid the selection of patients who require treatment from experienced surgeons.

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“…In this issue, Rodriguez de Santiago et al 3 attempt to tackle this knowledge gap. In a retrospective case-control study, the investigators used prospectively collected data to identify a cohort of 126 patients receiving antithrombotic treatment (anticoagulant and/or antiplatelet therapy).…”

mentioning

confidence: 99%

Contemporary management of antithrombotic agents for patients undergoing peroral endoscopic myotomy

Zhang

Ngamruengphong

2021

Gastrointestinal Endoscopy

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Safety and effectiveness of peroral endoscopic myotomy in patients on antiplatelet or anticoagulant therapy: an international multicenter case-control study

Cited by 8 publications

References 24 publications

Efficacy and Safety of Peroral Endoscopic Myotomy for Esophageal Achalasia and Achalasia-Related Diseases in Patients Aged 75 Years and Over

Efficacy and Safety of Peroral Endoscopic Myotomy for Esophageal Achalasia and Achalasia-Related Diseases in Patients Aged 75 Years and Over

Risk‐scoring system for predicting challenging cases of peroral endoscopic myotomy

Contemporary management of antithrombotic agents for patients undergoing peroral endoscopic myotomy

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