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Study suggests POEM safe, identifies predictors of complications
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Peroral endoscopic myotomy, or POEM, is a relatively safe procedure for the treatment of achalasia, according to the results of a large international multicenter case-control study.
Data from the study of more than 1,800 procedures revealed a 7.5% overall prevalence of adverse events, and identified several predictors of complications.
“Data largely from single-center studies and small case series have suggested POEM as a safe alternative to Heller myotomy,” investigators wrote. “However, the safety of POEM is still debated since comprehensive analysis of adverse events (AEs) associated with POEM in large multicenter cohort studies has not been performed.”
Therefore, the researchers retrospectively reviewed data on 1,826 patients who underwent POEM for achalasia or spastic esophageal disorders at 12 tertiary care centers in the U.S., Europe, Asia and Australia between June 2009 and November 2015.
They found that 156 AEs occurred in 137 patients (7.5%; mean age, 55 years; 44.5% women), including 116 mild AEs (6.4%), 31 moderate AEs (1.7%) and nine severe AEs (0.5%). No fatal AEs related to the procedure occurred, and 2.6% of patients needed surgery to treat their AE.
Inadvertent mucosotomy (2.8%), symptomatic capnoperitoneum (1.2%) and esophageal leak (0.7%) were the most common AEs.
Significant predictors of AEs included sigmoid-type esophagus (OR = 2.28), endoscopist experience (< 20 cases; OR = 1.98), triangular tip knife use (OR = 3.22), and use of electrosurgical current different from spray coagulation (OR = 3.09), based on multivariate analysis.
“This large multicenter study comprehensively assessed safety of POEM and highly suggests POEM as a relatively safe procedure when performed by experts at tertiary centers,” the researchers concluded, noting that “most of adverse events related to POEM can be managed conservatively or with minimally invasive procedures.” – by Adam Leitenberger
Disclosures: Several researchers report consulting relationships with Boston Scientific, Medtronic or Sandhill Scientific.
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