Related Experiment Video
Updated: Mar 2, 2026
Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia
Published on: March 3, 2023
Comprehensive Analysis of Adverse Events Associated With Per Oral Endoscopic Myotomy in 1826 Patients: An
Yamile Haito-Chavez1, Haruhiro Inoue2, Kristin W Beard3
1Division of Gastroenterology and Hepatology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Objectives:
The safety of peroral endoscopic myotomy (POEM) is still debated since comprehensive analysis of adverse events (AEs) associated with the procedure in large multicenter cohort studies has not been performed. To study (1) the prevalence of AEs and (2) factors associated with occurrence of AEs in patients undergoing POEM.
Methods:
Patients who underwent POEM at 12 tertiary-care centers between 2009 and 2015 were included in this case-control study. Cases were defined by the occurrence of any AE related to the POEM procedure. Control patients were selected for each AE case by matching for age, gender, and disease classification (achalasia type I and II vs. type III/spastic esophageal disorders).
Results:
A total of 1,826 patients underwent POEM. Overall, 156 AEs occurred in 137 patients (7.5%). A total of 51 (2.8%) inadvertent mucosotomies occurred. Mild, moderate, and severe AEs had a frequency of 116 (6.4%), 31 (1.7%), and 9 (0.5%), respectively. Multivariate analysis demonstrated that sigmoid-type esophagus (odds ratio (OR) 2.28, P=0.05), endoscopist experience <20 cases (OR 1.98, P=0.04), use of a triangular tip knife (OR 3.22, P=0.05), and use of an electrosurgical current different than spray coagulation (OR 3.09, P=0.02) were significantly associated with the occurrence of AEs.
Conclusions:
This large study comprehensively assessed the safety of POEM and highly suggests POEM as a relatively safe procedure when performed by experts at tertiary centers with an overall 7.5% prevalence of AEs. Severe AEs are rare. Sigmoid-type esophagus, endoscopist experience, type of knife, and current used can be considered as predictive factors of AE occurrence.
Insights
Peroral endoscopic myotomy (POEM) is a safe procedure with a 7.5% adverse event (AE) rate. Factors like sigmoid esophagus and less endoscopist experience predict AEs.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Patient Safety
Background:
- The safety of peroral endoscopic myotomy (POEM) remains under investigation due to limited large-scale multicenter data on adverse events (AEs).
- Comprehensive analysis of AEs is crucial for establishing POEM's safety profile.
Purpose of the Study:
- To determine the prevalence of AEs in patients undergoing POEM.
- To identify factors associated with the occurrence of AEs during POEM procedures.
Main Methods:
- A multicenter case-control study included 1,826 patients who underwent POEM between 2009 and 2015.
- Cases were defined as patients experiencing any POEM-related AE; controls were matched for age, gender, and disease classification.
- Multivariate analysis was used to identify factors associated with AE occurrence.
Main Results:
- The overall AE prevalence was 7.5% (156 AEs in 137 patients), with 2.8% inadvertent mucosotomies.
- Mild, moderate, and severe AEs occurred in 6.4%, 1.7%, and 0.5% of patients, respectively.
- Sigmoid-type esophagus, less than 20 prior POEM cases by the endoscopist, use of a triangular tip knife, and use of electrosurgical current other than spray coagulation were significantly associated with AEs.
Conclusions:
- POEM is a relatively safe procedure with a low rate of severe AEs when performed by experienced endoscopists in tertiary centers.
- AE prevalence is 7.5%, with specific patient and procedural factors identified as predictors.
- Understanding these predictive factors can aid in optimizing POEM safety and patient outcomes.
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