Anonymous User
Login / Registration

Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2019; 73(3): 208–214. doi:10.14735/amgh2019208.

Periprocedural complications of POEM

Lenka Nosáková, Martin Ďuriček, Peter Bánovčin, Zuzana Trabalková, Rudolf Hyrdel, Michal Demeter

Summary

Introduction: Achalasia is a rare primary esophageal motility disorder characterized by aperistalsis and the concomitant absence of relaxation of the lower esophageal sphincter. The introduction of a new technique, called peroral endoscopic myotomy (POEM), significantly advanced treatment of this condition. This study focused on the periprocedural complications of POEM. Methods: The incidence of periprocedural complications in patients with esophageal achalasia who had undergone POEM was retrospectively analyzed. Results: POEM was successfully performed in 132 of 136 patients. POEM was anterior in most patients (n = 109) and posterior in 23 patients. Fifty patients (38%) experienced complications during surgery. The most frequent complication was thermal damage of the mucosa (27.3%). The second most common complication was capnoperitoneum (14%). Severe capnoperitoneum occurred in five patients (3.8%). Subcutaneous emphysema was observed in six patients (4.5%). Seven patients (6%) experienced periprocedural perforation. Among all patients who developed complications, two required subsequent surgical treatment. There was no performance-related death in our patient population. Conclusion and discussion: POEM is a worldwide accepted therapy for achalasia. It is generally considered to be a safe method with a low incidence of serious complications. Data concerning the incidence of perioperative complications vary, particularly with regard to what is considered to be a complication and what is a normal part of surgery. However, severe life-threatening complications are rare.

Keywords

POEM, achalasia, periprocedural complications

To read this article in full, please register for free on this website.

Benefits for subscribers

Benefits for logged users

Literature

1. Laurino-Neto RM, Herbella F, Schlottmann F et al. Evaluation of esophageal achalasia: from symtoms to the Chicago classification. Arq Bras Cir Dig 2018; 31 (2): e1376. doi: 10.1590/ 0102-672020180001e1376.
2. Mari A, Patel K, Mahamid M et al. Achalasia: insight into diagnostic and therapeutic advances for an ancient disease. Rambam Maimonides Med J 2019; 10 (1). doi: 10.5041/RMMJ.10361.
3. Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet 2014; 383 (9911): 83–93. doi: 10.1016/S0140-6736 (13) 60651-0.
4. Schlottmann F, Patti MG. Esophageal achalasia: current diagnosis and treatment. Expert Rev Gastroenterol Hepatol 2018; 12 (7): 711–721. doi: 10.1080/17474124.2018.1481748.
5. Schlottmann F, Neto RM, Herbella FA et al. Esophageal achalasia: pathophysiology, clinical presentation, and diagnostic evaluation. Am Surg 2018; 84 (4): 467–472.
6. Fisichella PM, Jalilvand A, Lebenthal A. Diagnostic evaluation of achalasia: from the whalebone to the Chicago classification. World J Surg 2015; 39 (7): 1593–1597. doi: 10.1007/ s00268-014-2939-7.
7. Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 2013; 108 (8): 1238–1249. doi: 10.1038/ajg.2013.196.
8. Hyrdel R, Bánovčín P, Ďuríček M. Poruchy motility pažeráka – Chicagska klasifikácia, v3.0. Gastroent Hepatol 2015; 69 (2): 130–138. doi: 10.14735/amgh2015130.
9. Kahrilas PJ, Bredenoord AJ, Fox M et al. Expert consensus document: advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes. Nat Rev Gastroenterol Hepatol 2017; 14 (11): 677–688. doi: 10.1038/nrgastro.2017.132.
10. Krajčiová J, Prochádzka R, Pintová J et al. Vzácný typ achalázie jícnu III. typu řešený perorální endoskopickou myotomií (POEM). Gastroent Hepatol 2013; 67 (4): 261–263.
11. Schlottmann F, Luckett DJ, Fine J et al. Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia. Ann Surg 2018; 267 (3): 451–460. doi: 10.1097/sla.0000000000002311.
12. Meng F, Li P, Wang Y et al. Peroral endoscopic myotomy compared with pneumatic dilation for newly diagnosed achalasia. Surg Endosc 2017; 31 (11): 4665–4672. doi: 10.1007/s00464-017-5530-0.
13. Talukdar R, Inoue H, Nageshwar Reddy D. Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis. Surg Endosc 2014; 29 (11): 3030–3046. doi: 10.1007/s00464-014-4040-6.
14. Wong I, Law S. Peroral endoscopic myotomy (POEM) for treating esophageal motility disorders. Ann Transl Med 2017; 5 (8): 192. doi: 10.21037/atm.2017.04.36.
15. Martinek J, Svecova H, Vackova Z et al. Per-oral endoscopic myotomy (POEM): mid-term efficacy and safety. Surg Endosc 2017; 32 (3): 1293–1302. doi: 10.1007/s00464-017-5807-3.
16. Martínek J, Rösch T, Špičák J et al. První „POEM“ (perorální endoskopická myotomie) v České republice. Gastroent Hepatol 2012; 66 (6): 475–476.
17. Inoue H, Minami H, Kobayasi Y et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 2010; 42 (4): 265–271. doi: 10.1055/s-0029-1244080.
18. Nabi Z, Reddy DN, Ramchandani M. Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management. Gastrointest Endosc 2018; 87 (1): 4–17. doi: 10.1016/j.gie.2017.09.029.
19. Gonzalez JM, Benezech A, Barthet M. Complications of submucosal endoscopy. Best Pract Res Clin Gastroenterol 2016; 30 (5): 783–791. doi: 10.1016/j.bpg.2016.10.015.
20. Crespin OM, Liu LW, Parmar A et al. Safety and efficacy of poem for treatment of achalasia: a systematic review of the literature. Surg Endosc 2017; 31 (5): 2187–2201. doi: 10.1007/s00464-016-5217-y.
21. Wang Y, Liu ZQ, Xu MD e al. Clinical and endoscopic predictors for intraprocedural mucosal injury during per-oral endoscopic myotomy. Gastrointest Endosc 2019; 89 (4): 769–778. doi: 10.1016/j.gie.2018.09.003.
22. Nosáková L, Ďuríček M, Bánovčin P et al. Periprocedurálne komplikácie POEM. Gastroent Hepatol 2019; 73 (3): 208–214.
23. Zhang XC, Li QL, Xu MD et al. Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis. Endoscopy 2016; 48 (11): 967–978. doi: 10.1055/s-0042-110397.
24. Ren Z, Zhong Y, Zhou P et al. Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc 2012; 26 (11): 3267–3272. doi: 10.1007/s00464-012-2336-y.

Kreditovaný autodidaktický test