Jan Friso Nast1, Christoph Berliner2, Thomas Rösch3,4, Daniel von Renteln5,6, Tania Noder5, Guido Schachschal5, Stefan Groth5, Harald Ittrich2, Jan F Kersten7, Gerhard Adam2, Yuki B Werner5. 1. Department of Gastroenterology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Diagnostic and Interventional Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 3. Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany. t.roesch@uke.de. 4. Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. t.roesch@uke.de. 5. Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 6. Department of Gastroenterology, Centre Hospitalier de l´Université de Montreal, Montreal, Canada. 7. Department of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND: The newly developed technique of peroral endoscopic myotomy (POEM) has been shown to be effective in several short- and mid-term studies. Limited information is available about the adequacy of immediate post-POEM monitoring tests. METHODS: POEM was performed under general anesthesia in 228 patients (59.6% male, mean age 45.6 ± 15.5 years). Post-procedural checks comprised clinical and laboratory examination, and, during post-procedure days 1-5, endoscopy and-in the first 114 cases-radiologic examination using water-soluble contrast (1st group); the remaining patients underwent post-procedure controls without radiology (2nd group). Main outcome was value of endoscopic compared to radiologic control for recognition of early adverse events. RESULTS: In the first group, routine fluoroscopic contrast swallow suggested minor leakages at the mucosal entry site in two cases which was confirmed endoscopically in only one. Endoscopy revealed two minor entry site leakages and, in six additional cases, dislocated clips without leakage (overall 5.3%). All eight patients underwent reclipping and healed without clinical sequelae. In the 2nd group, endoscopy showed 5 clip dislocations (all reclipped) and one ischemic cardiac perforation in a patient with clinical deterioration on post-POEM day 1 who had to undergo surgery after confirmation of leakage by CT. CONCLUSIONS: Radiologic monitoring (contrast swallow) after POEM is not useful and can be omitted. Even routine endoscopic monitoring for detection and closure of minor defects of the mucosal entry site yields limited information with regards to final outcome; major complications are very rare and probably associated with clinical deterioration. Clinical Trials Gov Registration number of the main study: NCT01405417.
BACKGROUND: The newly developed technique of peroral endoscopic myotomy (POEM) has been shown to be effective in several short- and mid-term studies. Limited information is available about the adequacy of immediate post-POEM monitoring tests. METHODS: POEM was performed under general anesthesia in 228 patients (59.6% male, mean age 45.6 ± 15.5 years). Post-procedural checks comprised clinical and laboratory examination, and, during post-procedure days 1-5, endoscopy and-in the first 114 cases-radiologic examination using water-soluble contrast (1st group); the remaining patients underwent post-procedure controls without radiology (2nd group). Main outcome was value of endoscopic compared to radiologic control for recognition of early adverse events. RESULTS: In the first group, routine fluoroscopic contrast swallow suggested minor leakages at the mucosal entry site in two cases which was confirmed endoscopically in only one. Endoscopy revealed two minor entry site leakages and, in six additional cases, dislocated clips without leakage (overall 5.3%). All eight patients underwent reclipping and healed without clinical sequelae. In the 2nd group, endoscopy showed 5 clip dislocations (all reclipped) and one ischemic cardiac perforation in a patient with clinical deterioration on post-POEM day 1 who had to undergo surgery after confirmation of leakage by CT. CONCLUSIONS: Radiologic monitoring (contrast swallow) after POEM is not useful and can be omitted. Even routine endoscopic monitoring for detection and closure of minor defects of the mucosal entry site yields limited information with regards to final outcome; major complications are very rare and probably associated with clinical deterioration. Clinical Trials Gov Registration number of the main study: NCT01405417.
Authors: Yuki B Werner; Guido Costamagna; Lee L Swanström; Daniel von Renteln; Pietro Familiari; Ahmed M Sharata; Tania Noder; Guido Schachschal; Jan F Kersten; Thomas Rösch Journal: Gut Date: 2015-04-30 Impact factor: 23.059
Authors: Daniel Von Renteln; Karl-Hermann Fuchs; Paul Fockens; Peter Bauerfeind; Melina C Vassiliou; Yuki B Werner; Gerald Fried; Wolfram Breithaupt; Henriette Heinrich; Albert J Bredenoord; Jan F Kersten; Tessa Verlaan; Michael Trevisonno; Thomas Rösch Journal: Gastroenterology Date: 2013-05-09 Impact factor: 22.682
Authors: Rym El Khoury; Ezra N Teitelbaum; Joel M Sternbach; Nathaniel J Soper; Carla B Harmath; John E Pandolfino; Peter J Kahrilas; Eric S Hungness Journal: Surg Endosc Date: 2015-10-20 Impact factor: 4.584