Safety and feasibility of performing peroral endoscopic myotomy as an outpatient procedure with same-day discharge

Benias, Petros C.; Korrapati, Praneet; Raphael, Kara L.; DʼSouza, Lionel S.; Inamdar, Sumant; Trindade, Arvind J.; Lee, Calvin; Kumbhari, Vivek; Sejpal, Divyesh V.; Okolo, Patrick I.; Khashab, Mouen A.; Miller, Larry S.; Carr‐Locke, David L.

doi:10.1016/j.gie.2019.04.247

Cited by 42 publications

(24 citation statements)

References 25 publications

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“…Although contrast esophagram is done by approximately 88% of facilities to detect esophageal leaks after POEM, 10 this technique is known to have a suboptimal diagnostic yield to detect clinically significant complications 16 . Esophageal leaks on esophagram may not be detected on POD 1 because dehiscence or mucosal breakdown can take several days to occur 17 . Although a recent study reported that POEM could be done as an outpatient procedure with same‐day discharge without conducting post‐POEM esophagram nor endoscopy, it showed two out of 101 patients with elevated temperature and white blood cell, which consequently revealed mucosal perforation 17 .…”

Section: Discussionmentioning

confidence: 99%

“…Esophageal leaks on esophagram may not be detected on POD 1 because dehiscence or mucosal breakdown can take several days to occur 17 . Although a recent study reported that POEM could be done as an outpatient procedure with same‐day discharge without conducting post‐POEM esophagram nor endoscopy, it showed two out of 101 patients with elevated temperature and white blood cell, which consequently revealed mucosal perforation 17 . Bearing the potential severity of mediastinitis or peritonitis in mind, endoscopic examination before resuming oral ingestion help to detect even small dehiscence of entry site or a mucosal perforation, which may be overlooked by esophagram.…”

Section: Discussionmentioning

confidence: 99%

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Importance of second‐look endoscopy after per‐oral endoscopic myotomy for safe postoperative management

Fujiyoshi

Inoue

Abad

et al. 2020

Digestive Endoscopy

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Objectives Per‐oral endoscopic myotomy (POEM) is a safe and effective treatment for achalasia and esophageal motility disorders. The role of second‐look endoscopy (SE) on postoperative day 1 has not been examined. This study aimed to evaluate the findings and need of SE after POEM. Methods This is a single‐center, retrospective study. All consecutive patients who underwent POEM and SE on postoperative day 1 between December 2017 and September 2019 were included. The primary endpoint was the rate of newly‐detected adverse events (nAE) during SE that required endoscopic intervention or deviation from the normal postoperative course. Multivariate logistic regression was used to identify predictors of nAE. Results Four‐hundred‐ninety‐seven patients (mean age, 50.3 years; female, 49.9%) were included. SE identified abnormal findings in a total of 71 patients (14.3%). nAE which required endoscopic intervention or deviation from the normal postoperative course were identified in 12 patients (2.4%): eight (1.6%) entry site dehiscence; two (0.4%) submucosal hemorrhage or hematoma; and two (0.4%) dehiscence of an intraoperative perforation site after endoclip closure. Other findings such as mucosal thermal damage without perforation and small submucosal hematoma were found in 54 patients (10.9%) and five patients (1.0%), respectively. Multivariate analysis showed that longer operation time and intraoperative adverse events (AE) were associated with clinically significant nAE during SE. Conclusions Second‐look endoscopy can detect and treat nAE that may lead to severe AE. Thus, SE should be highly considered before starting oral ingestion in all cases, and especially in those who present an intraoperative AE and longer operation time.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Importance of second‐look endoscopy after per‐oral endoscopic myotomy for safe postoperative management

Fujiyoshi

Inoue

Abad

et al. 2020

Digestive Endoscopy

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“…As efforts to perform POEM on an outpatient basis with same-day discharge are being considered worldwide, practitioners of POEM need to be cognizant of all potential delayed complications, including tension pneumoperitoneum, to prompt corrective action. 2 , 3 Expectant management of incidental prolonged pneumoperitoneum may be advised when no constitutional signs and symptoms are identified.…”

Section: Case Reportmentioning

confidence: 99%

Delayed Pneumoperitoneum After Peroral Endoscopic Myotomy

Podboy

Ashhab

2021

ACG Case Rep J

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“…Heller myotomy or newer minimally invasive POEM (peroral endoscopic (LES) myotomy) procedures provide a longer duration relief for achalasia sufferers and can be performed safely as day case procedures. 66 HRM provides diagnostic information and guidance on the length of myotomy at the LES. 67 The recently described G-POEM (gastric POEM) has similarly shown promise in improving gastric emptying by reducing pyloric outlet obstruction.…”

Section: Therapymentioning

confidence: 99%

Aspects of the assessment and management of pharyngoesophageal dysphagia

Allen

Dewan

Herbert

et al. 2020

Annals of the New York Academy of Sciences

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Swallowing complaints are common and may have significant consequences for nutrition and pulmonary health. Etiology varies and different aspects of the deglutitive system may be affected. A thorough assessment from the oral cavity to the stomach will provide physiologic information that enables specific targeted management plans to be devised. Although the swallow trajectory bridges anatomic areas, there has previously been a tendency to compartmentalize assessment and treatment by arbitrary anatomic boundaries. It is now clear that this approach fails to appreciate the complexity of swallow mechanics and that systems (oral, pharyngeal, esophageal, and pulmonary) are intertwined and codependent. Swallowing specialists from different backgrounds and with complementary skill sets form a multidisciplinary team that can provide insight and address multiple areas of management. With the advent of new tools for instrumental evaluation, such as manometry, targeted rehabilitative strategies can be informed by physiology, increased in precision and breadth, and assessed quantitatively. Surgical approaches have evolved toward endoscopic techniques, and food technology is expanding options in dietary management. The multidisciplinary team is core to managing this varied and often neglected patient population. This review is for clinicians treating swallowing disorders and will explore the selected aspects of the assessment and management of pharyngoesophageal swallowing disorders.

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Safety and feasibility of performing peroral endoscopic myotomy as an outpatient procedure with same-day discharge

Cited by 42 publications

References 25 publications

Importance of second‐look endoscopy after per‐oral endoscopic myotomy for safe postoperative management

Importance of second‐look endoscopy after per‐oral endoscopic myotomy for safe postoperative management

Delayed Pneumoperitoneum After Peroral Endoscopic Myotomy

Aspects of the assessment and management of pharyngoesophageal dysphagia

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