Advanced Endoscopy Fellows Program | September 2024-POEM adverse events

POEM adverse events

Pdf Summary

Per-oral endoscopic myotomy (POEM) has emerged as a viable endoscopic treatment for achalasia cardia (AC). POEM can be performed safely in an endoscopy suite, resulting in fewer major adverse events (AEs). Common intraoperative AEs include insufflation-related complications, mucosal injuries, bleeding, pain, and aspiration pneumonia. Most gas-related AEs are minor and often do not require intervention, but should still be recognized early for management if needed.<br /><br />Postoperative AEs such as leaks, delayed bleeding, and delayed mucosal perforations can be challenging to diagnose and manage due to a lack of standardized classification for grading AEs’ severity. A large percentage of gas-related AEs (subcutaneous emphysema, pneumothorax, pneumomediastinum, and pneumoperitoneum) are often detected incidentally, emphasizing the importance of using CO2 instead of air during insufflation due to its higher diffusion capacity and quicker absorption.<br /><br />Mucosal injuries (MIs) occur in about 4.8% of POEM cases, compared to 0.6% in Heller myotomy and 4.8% in pneumatic dilation. MIs can be minimized by careful technique and attention to potential risk factors such as submucosal fibrosis and unhealthy mucosa. Procedures during the learning curve are especially prone to these injuries.<br /><br />Intraprocedural bleeding is generally minor, and significant bleeding requiring intervention is rare. Postoperative pain is common but usually subsides within a day, and effective pain management strategies include the use of acetaminophen.<br /><br />Aspiration pneumonia is rare and can be mitigated with pre-procedural precautions. Long-term GERD is prevalent post-POEM and requires further investigation, especially regarding procedural factors influencing its occurrence. <br /><br />There is an emphasis on creating standardized reporting and classification for AEs associated with POEM to facilitate better comparative studies and improved patient outcomes. Studies suggest that experience reduces the incidence of these events, yet early recognition and preventive measures remain crucial.

Keywords

POEM

achalasia cardia

endoscopic treatment

adverse events

mucosal injuries

intraprocedural bleeding

aspiration pneumonia

gas-related complications

postoperative pain

GERD