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

      Background and Aims

      Peroral endoscopic myotomy (POEM) has emerged as a promising treatment option for achalasia and other foregut dysmotility disorders. However, much of the current postprocedural care, such as mandatory admission and routine esophagrams, has been adapted from current surgical practices and may not in fact be necessary. Here, we describe our algorithm and outcomes for same-day discharge.

      Methods

      Outcomes of 103 consecutive patients who underwent POEM for achalasia and other foregut dysmotility disorders from January 2015 to December 2018 were analyzed. Patients were discharged on the same day without esophagrams following a predetermined algorithm based on procedural adverse events and postprocedural pain. Patients were closely monitored after discharge for adverse events at 24 and 48 hours and then routinely in the office setting.

      Results

      Of the 103 POEMs, 101 were completed successfully. A total of 62.4% of patients were discharged safely on the same day, 29.7% were admitted for mild pain, and 7.9% were admitted for observation for other reasons. Overall, there were no serious adverse events at any time point. Univariate analysis identified duration of disease greater than 3 years, longer length of procedure (50.9 vs 68.5 min, P < .0001), and longer length of myotomy (7.2 vs 8.5 cm, P < .0068) as significant factors associated with postprocedural pain requiring admission.

      Conclusions

      Although same-day discharge and foregoing routine esophagram have been suggested by many, this routine has not been systematically implemented. This series suggests that an algorithm for same-day discharge based on postprocedure chest pain and procedural complexity is both safe and feasible.

      Abbreviations:

      AE (adverse event), POEM (peroral endoscopic myotomy), SEDs (spastic esophageal disorder), WBC (white blood cell count)
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      Linked Article

      • Treatment of achalasia by Performing Outpatient Endoscopic Myotomy (POEM)
        Gastrointestinal EndoscopyVol. 90Issue 4
        • Preview
          Achalasia is a rare idiopathic condition defined by degeneration of ganglia in the esophageal myenteric plexus, leading to aperistalsis and failed relaxation of the lower esophageal sphincter.1 Progressive dysphagia and regurgitation often result in clinically significant weight loss and failure to thrive.2 Historically, achalasia was definitively treated with a laparoscopic Heller myotomy with or without concomitant partial fundoplication. More recently described, peroral endoscopic myotomy (POEM) is a minimally invasive, yet definitive, flexible endoscopic surgery, which mirrors the conventional laparoscopic surgical myotomy in both form and function.
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