Periprocedural complications of POEM

Česká verzia

Authors: L. Nosáková ¹ ; Ďuriček M. ¹; P. Bánovčin Jr. ¹ ; Trabalkova Z. ²; Hyrdel R. ¹; Demeter M. ¹
Authors place of work: Interná klinika gastroenterologická JLF UK a UN Martin ¹; Radiologická klinika JLF UK a UN Martin ²
Published in the journal: Gastroent Hepatol 2019; 73(3): 208-214
Category: Digestive Endoscopy: Original Article
doi: https://doi.org/10.14735/amgh2019208

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:

achalasia – POEM – periprocedural complications

Zdroje

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.