Complications of submucosal endoscopy.

Area of Science:

• Gastroenterology
• Endoscopic Surgery

Background:

• Submucosal endoscopy encompasses procedures like peroral endoscopic esophageal myotomy (POEM), pyloromyotomy, and tunnel tumor resections.
• POEM is associated with a 5-10% complication rate, including gas-related issues, mucosal tears, and bleeding.

Purpose of the Study:

• To review the complications associated with submucosal endoscopic procedures, focusing on POEM.
• To identify risk factors for complications and discuss management strategies.
• To emphasize the importance of training in minimizing procedural risks.

Main Methods:

• Review of existing literature on submucosal endoscopic procedures, particularly POEM.
• Analysis of reported complication rates, types, and management strategies.
• Identification of risk factors such as operator experience and esophageal anatomy.

Main Results:

• POEM complications occur in 5-10% of cases, with conservative or endoscopic management typically successful.
• Gastro-esophageal reflux (GERD) affects 10-30% of patients post-POEM, responding well to proton pump inhibitors.
• Limited data exists for other submucosal techniques due to small case numbers.

Conclusions:

• Complications from POEM are generally manageable, but risk factors like limited experience and specific esophageal types increase incidence.
• Appropriate training and adherence to learning programs are vital for endoscopists to reduce complication rates.
• Further research is needed for less common submucosal endoscopic procedures.