Y Ichkhanian1, K Vosoughi1, M Aghaie Meybodi1, J Jacques2, A Sethi3, A A Patel3, A A Aadam4, J R Triggs4, A Bapaye5, S Dorwat5, P Benias6, D M Chaves7, M Barret8,9, R J Law10, N Browers10, M Pioche11, P V Draganov12, A Kotzev13, F Estremera13, E Albeniz14, M B Ujiki15, Z M Callahan15, M I Itani1, O G Brewer1, M A Khashab16,17. 1. Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA. 2. Gastroenterology Department, Limoges University Hospital, 2 Avenue Martin Luther King, 87042, Rouen, France. 3. Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA. 4. Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 5. Department of Digestive Diseases & Endoscopy, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India. 6. Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, NY, USA. 7. Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil. 8. Gastroenterology Unit, Cochin University Hospital, Université Paris Descartes, Paris, France. 9. Unité INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. 10. University of Michigan Health Care System, Ann Arbor, USA. 11. Service d'Hépato-gastro-entérologie, Hôpital Edouard Herriot, CHU Lyon, Lyon, France. 12. Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA. 13. Clinic of Gastroenterology, University Hospital "Alexandrovska", Sofia, Bulgaria. 14. Division of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain. 15. Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL, USA. 16. Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA. mkhasha1@jhmi.edu. 17. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Sheikh Zayed Bldg, 1800 Orleans Street, Suite 7125G, Baltimore, MD, 21287, USA. mkhasha1@jhmi.edu.
Abstract
BACKGROUND: Gastric peroral endoscopic myotomy (G-POEM) has emerged as an effective management approach for patients with refractory gastroparesis. This study aims to comprehensively study the safety of G-POEM and describe the predictive factors of adverse events (AEs) occurrence. METHODS: This study is a retrospective study involving 13 tertiary care centers (7 USA, 1 South America, 4 Europe, and 1 Asia). Patients who underwent G-POEM for refractory gastroparesis were included. Cases were identified by the occurrence of AEs. For each case, two controls were randomly selected and matched for age (± 10 years), gender, and etiology of gastroparesis. RESULTS: A total of 216 patients underwent G-POEM for gastroparesis. Overall, 31 (14%) AEs were encountered [mild 24 (77%), moderate 5 (16%), and severe 2 (6%)] during the duration of the study. The most common AE was abdominal pain (n = 16), followed by mucosotomy (n = 5) and capnoperitoneum (n = 4), and AEs were most commonly identified within the first 48-h post-procedure 18 (58%). The risk of adverse event occurrence was significantly higher for endoscopists with experience of < 20 G-POEM procedures (OR 3.03 [1.03-8.94], p < 0.05). CONCLUSION: G-POEM seems to be a safe intervention for refractory gastroparesis. AEs are most commonly mild and managed conservatively. Longitudinal mucosal incision, use of hook knife, use of clips for mucosal closure and endoscopist's experience with > 20 G-POEM procedures is significantly associated with decreased incidence of AEs.
BACKGROUND: Gastric peroral endoscopic myotomy (G-POEM) has emerged as an effective management approach for patients with refractory gastroparesis. This study aims to comprehensively study the safety of G-POEM and describe the predictive factors of adverse events (AEs) occurrence. METHODS: This study is a retrospective study involving 13 tertiary care centers (7 USA, 1 South America, 4 Europe, and 1 Asia). Patients who underwent G-POEM for refractory gastroparesis were included. Cases were identified by the occurrence of AEs. For each case, two controls were randomly selected and matched for age (± 10 years), gender, and etiology of gastroparesis. RESULTS: A total of 216 patients underwent G-POEM for gastroparesis. Overall, 31 (14%) AEs were encountered [mild 24 (77%), moderate 5 (16%), and severe 2 (6%)] during the duration of the study. The most common AE was abdominal pain (n = 16), followed by mucosotomy (n = 5) and capnoperitoneum (n = 4), and AEs were most commonly identified within the first 48-h post-procedure 18 (58%). The risk of adverse event occurrence was significantly higher for endoscopists with experience of < 20 G-POEM procedures (OR 3.03 [1.03-8.94], p < 0.05). CONCLUSION: G-POEM seems to be a safe intervention for refractory gastroparesis. AEs are most commonly mild and managed conservatively. Longitudinal mucosal incision, use of hook knife, use of clips for mucosal closure and endoscopist's experience with > 20 G-POEM procedures is significantly associated with decreased incidence of AEs.
Authors: Jan Martinek; Rastislav Hustak; Jan Mares; Zuzana Vackova; Julius Spicak; Eva Kieslichova; Marie Buncova; Daniel Pohl; Sunil Amin; Jan Tack Journal: Gut Date: 2022-04-25 Impact factor: 31.793