Per-oral endoscopic myotomy (POEM) has surfaced as an effective endoscopic treatment
modality for achalasia cardia (AC). Promising results in short- and mid-term follow-up
studies have increased the use of POEM for the management of AC. POEM can be safely
performed in an endoscopy suit, and major adverse events (AEs) are uncommon. AEs encountered
during POEM or during the perioperative period principally include insufflation-related
AEs, mucosal injuries, bleeding, pain, and aspiration pneumonia. Most insufflation-related
AEs do not require an active intervention and therefore should not be considered as
AEs in the true sense. When management of AEs is required, most intraoperative AEs
can be managed at the same time without untoward consequences. Occurrences of AEs
lessen after completion of the learning curve. However, experience alone does not
ensure “zero” incidence of AEs, and early recognition remains essential. Postoperative
AEs, like leaks, delayed bleeding, and delayed mucosal perforations, may pose special
challenges for diagnosis and management. There is no standardized classification system
for grading the severity of AEs associated with POEM, resulting in wide variation
in their reported occurrences. Uniform reporting of AEs is not only crucial to comprehensively
analyze the safety of POEM but also for comparison with other established treatment
modalities like Heller’s myotomy. GERD is an important long-term AE after POEM. Unlike
the perioperative AEs, little is known regarding the intraoperative or patient-related
factors that influence the occurrence of post-POEM GERD. Large prospective studies
with long-term follow-up are required to determine the procedural factors associated
with GERD after POEM.
Abbreviations:
AC (achalasia cardia), AEs (adverse events), MI (mucosal injury), POEM (per-oral endoscopic myotomy)To read this article in full you will need to make a payment
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References
- Comprehensive analysis of efficacy and safety of peroral endoscopic myotomy performed by a gastroenterologist in the endoscopy unit: a single-center experience.Gastrointest Endosc. 2016; 83: 117-125
- The choice of myotomy in achalasia cardia: Heller's or per-oral endoscopic myotomy.Saudi J Gastroenterol. 2017; 23: 73-74
- Per-oral endoscopic myotomy for achalasia cardia: outcomes in over 400 consecutive patients.Endosc Int Open. 2017; 5: E331-E339
- Achalasia cardia—recent advances in diagnosis and endoscopic management.J Gastrointest Dig Syst. 2016; 6: 393
- Tension capnopericardium and cardiac arrest as an unexpected adverse event of peroral endoscopic myotomy (with video).Gastrointest Endosc. 2015; 82: 1137-1139
- Prospective evaluation of CT esophagram findings after peroral endoscopic myotomy.Gastrointest Endosc. 2016; 84: 408-415
- Peroral endoscopic myotomy: a meta-analysis.Endoscopy. 2016; 48: 1059-1068
- Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis.Endoscopy. 2016; 48: 967-978
- 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: 3267-3272
- Thoracic CT after peroral endoscopic myotomy for the treatment of achalasia.Gastrointest Endosc. 2014; 80: 1046-1055
- Pneumomediastinum and pneumoperitoneum on computed tomography after peroral endoscopic myotomy (POEM): postoperative changes or complications?.Acta Radiol. 2015; 56: 1216-1221
- Fluoroscopic findings post-peroral esophageal myotomy.Abdom Imaging. 2015; 40: 237-245
- Findings of esophagography for 25 patients after peroral endoscopic myotomy for achalasia.AJR Am J Roentgenol. 2016; 207: 1185-1193
- Comprehensive analysis of adverse events associated with per oral endoscopic myotomy in 1826 patients: an international multicenter study.Am J Gastroenterol. 2017; 112: 1267-1276
- Risk factors for gas-related complications of peroral endoscopic myotomy in achalasia.Netherlands J Med. 2015; 73: 76-81
- Per-oral endoscopic myotomy, 1000 cases later: pearls, pitfalls, and practical considerations.Gastrointest Endosc. 2016; 84: 330-338
- Peroral endoscopic myotomy for achalasia cardia: treatment analysis and follow up of over 200 consecutive patients at a single center.Dig Endosc. 2016; 28: 19-26
- Peroral endoscopic myotomy for esophageal achalasia: outcomes of the first 100 patients with short-term follow-up.Ann Surg. 2016; 263: 82-87
- Anesthesia in per-oral endoscopic myotomy: a large tertiary care centre experience.Indian J Gastroenterol. 2017; 36: 305-312
- Pneumopericardium due to delayed esophageal leak after per oral endoscopic myotomy (POEM).Chest. 2016; 150: 671A
- Tension Pneumopericardium during peroral endoscopic myotomy: a case report and review of literature.Chest. 2016; 150: 265A
- Laparoscopic Heller's myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized, controlled trials.Gastrointest Endosc. 2013; 78: 468-475
- Submucosal fibrosis in achalasia patients is a rare cause of aborted peroral endoscopic myotomy procedures.Endoscopy. 2017; 49: 736-744
- Early adverse events of per-oral endoscopic myotomy.Gastrointest Endosc. 2016; 85: 708-718
- Endoscopic suturing versus endoscopic clip closure of the mucosotomy during a per-oral endoscopic myotomy (POEM): a case-control study.Surg Endosc. 2016; 30: 2132-2135
- Endoscopic suture repair of full-thickness esophagotomy during per-oral esophageal myotomy for achalasia.Surg Endosc. 2013; 27: 3910
- Successful use of a covered, retrievable stent to seal a ruptured mucosal flap safety valve during peroral endoscopic myotomy in a child with achalasia.Endoscopy. 2013; 45: E63-E64
- An alternative method for mucosal flap closure during peroral endoscopic myotomy using an over-the-scope clipping device.Endoscopy. 2013; 45: 579-581
- Closure methods in submucosal endoscopy.Gastrointest Endosc. 2014; 80: 894-895
- Efficacy of peroral endoscopic myotomy (POEM) in the treatment of achalasia: a systematic review and meta-analysis.Surg Endosc. 2015; 29: 3030-3046
- Evaluation of the need for routine esophagram after peroral endoscopic myotomy (POEM).Surg Endosc. 2016; 30: 2969-2974
- Evaluation of anesthesia management, feasibility and efficacy of peroral endoscopic myotomy (POEM) for achalasia performed in the endoscopy unit.Endosc Int Open. 2015; 3: E289-E295
- Peroral endoscopic myotomy: technique of mucosal incision.Clin Gastroenterol Hepatol. 2014; 12: 900-901
- The International Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience.Surg Endosc. 2013; 27: 3322-3338
- Early diagnosis and management of delayed bleeding in the submucosal tunnel after peroral endoscopic myotomy for achalasia (with video).Gastrointest Endosc. 2013; 78: 370-374
- Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study.Am J Gastroenterol. 2012; 107: 411-417
- Esophageal hematoma after peroral endoscopic myotomy for achalasia in a patient on antiplatelet therapy.Endoscopy. 2015; 47: E363-E364
- Peroral endoscopic myotomy for the treatment of achalasia: a clinical comparative study of endoscopic full-thickness and circular muscle myotomy.J Am Coll Surg. 2013; 217: 442-451
- Systematic review and meta-analysis of perioperative outcomes of peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) for achalasia.Surg Laparosc Endosc Percutan Techn. 2017; 27: 123-131
- Reduced postoperative pain scores and narcotic use favor per-oral endoscopic myotomy over laparoscopic Heller myotomy.Surg Endosc. 2017; 31: 795-800
- Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician.Med Devices. 2017; 10: 53-59
- Peroral endoscopic myotomy-initial experience with anesthetic management of 24 procedures and systematic review.Anesth Essays Res. 2016; 10: 297-300
- Peroral endoscopic myotomy: time to change our opinion regarding the treatment of achalasia?.World J Gastrointest Endosc. 2015; 7: 237-246
- Anesthetic management of peroral endoscopic myotomy for esophageal achalasia: a retrospective case series.J Anesth. 2014; 28: 456-459
- Preventing aspiration during peroral endoscopic myotomy.J Anesth. 2014; 28: 959
- Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis.Dis Esoph. 2016; 29: 807-819
- Peroral endoscopic myotomy for esophageal achalasia: outcomes of the first over 100 patients with short-term follow-up.Surg Endosc. 2016; 30: 4817-4826
- Gentamicin submucosal lavage during peroral endoscopic myotomy (POEM): a retrospective analysis.Surg Endosc. 2017; https://doi.org/10.1007/s00464-017-5677-8
- Laparoscopic Heller myotomy versus peroral endoscopic myotomy (POEM) for achalasia: a systematic review and meta-analysis.Ann Surg. 2017 May 25; https://doi.org/10.1097/SLA 000000000000 2 311
- 24-h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy.Aliment Pharmacol Ther. 2010; 32: 1257-1265
- Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia.N Engl J Med. 2011; 364: 1807-1816
- Pneumatic dilation versus laparoscopic Heller myotomy for the treatment of achalasia: variables related to a good response.Dis Esoph. 2014; 27: 18-23
- Gastroesophageal reflux disease after peroral endoscopic myotomy: analysis of clinical, procedural and functional factors, associated with gastroesophageal reflux disease and esophagitis.Dig Endosc. 2016; 28: 33-41
- Gastroesophageal reflux symptoms do not correlate with objective pH testing after peroral endoscopic myotomy.Surg Endosc. 2016; 30: 947-952
- Gastroesophageal reflux after peroral endoscopic myotomy: a multicenter case-control study.Endoscopy. 2017; 49: 634-642
- A prospective analysis of GERD after POEM on anterior myotomy.Surg Endosc. 2016; 30: 2496-2504
- Full-thickness myotomy is associated with higher rate of postoperative gastroesophageal reflux disease.World J Gastroenterol. 2016; 22: 9419-9426
- Per-oral endoscopic myotomy (POEM) after the learning curve: durable long-term results with a low complication rate.Ann Surg. 2016; 264: 508-517
- Clinical response to peroral endoscopic myotomy in patients with idiopathic achalasia at a minimum follow-up of 2 years.Gut. 2016; 65: 899-906
- Learning curve for peroral endoscopic myotomy.Endosc Int Open. 2016; 4: E577-E582
- Peroral endoscopic esophageal myotomy: defining the learning curve.Gastrointest Endosc. 2013; 77: 719-725
- Analysis of a learning curve and predictors of intraoperative difficulty for peroral esophageal myotomy (POEM).J Gastrointest Surg. 2014; 18 (discussion 8-9): 92-98
- Ling classification applied in the preoperative safety and effectiveness assessment of POEM.Surg Endosc. 2017; 31: 368-373
- New endoscopic classification of achalasia for selection of candidates for peroral endoscopic myotomy.World J Gastroenterol. 2013; 19: 556-560
- An international multicenter study evaluating the clinical efficacy and safety of per-oral endoscopic myotomy in octogenarians.Gastrointest Endosc. 2017; https://doi.org/10.1016/j.gie.2017.02.007
- Optical coherence tomography (OCT) prior to peroral endoscopic myotomy (POEM) reduces procedural time and bleeding: a multicenter international collaborative study.Surg Endosc. 2016; 30: 5126-5133
- Peroral endoscopic myotomy for idiopathic achalasia: randomized comparison of water-jet assisted versus conventional dissection technique.Surg Endosc. 2014; 28: 1158-1165
- A retrospective study of peroral endoscopic full-thickness myotomy in patients with severe achalasia.J Laparoendosc Adv Surg Techn Part A. 2017; 27: 770-776
Article info
Publication history
Published online: October 05, 2017
Accepted:
September 20,
2017
Received:
July 24,
2017
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2018 by the American Society for Gastrointestinal Endoscopy
