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Published on: March 3, 2023
Gentamicin submucosal lavage during peroral endoscopic myotomy (POEM): a retrospective analysis
Julia Bayer1,2, Zuzana Vackova1, Hana Svecova3
1Department of Hepatogastroenterology, IKEM, Videnska 1958/9, 140 21, Prague 4, Czech Republic.
Background And Aims:
Peroral endoscopic myotomy (POEM) is an evolving therapeutic modality for achalasia. According to the original Inoue's technique, a submucosal lavage with gentamicin has been practiced due to the fear of infection. This single-tertiary center study was intended to assess the clinical significance of the topical antibiotic lavage during POEM.
Methods:
A retrospective analysis of prospectively collected data was conducted. The outcomes of patients who received the gentamicin lavage (group A) during POEM were compared to those who did not (group B). The main outcome variables were infectious adverse events, post-POEM fever, and markers of systemic inflammatory response. One day before and after POEM, all patients received systemic antibiotic prophylaxis with ceftriaxone.
Results:
Of 124 consecutive patients having undergone POEM, 60 patients received a lavage with 80 mg of gentamicin into the submucosal tunnel before starting the myotomy, while 64 patients did not. The overall treatment success at 3 months did not differ between the two groups (group A 94.7 vs. 97.5% group B). We did not experience any significant infectious adverse events in either group. CRP and WBC levels were lower in patients with lavage versus those without [CRP: median 52.7 (IQR 34.9) vs. 69.5 (54.1); p = 0.01; WBCs: median 10.9 (IQR 3.3) vs. 12.6 (3.9); p < 0.01]. Post-procedural fever was present in 10% of patients in either group.
Conclusions:
During POEM, the submucosal lavage with gentamicin prior to the myotomy does not play a role in the prevention of clinically significant infectious adverse events, although the systemic inflammatory response may be decreased.
Insights
Topical antibiotic lavage during peroral endoscopic myotomy (POEM) for achalasia does not prevent infections. However, gentamicin lavage may reduce the systemic inflammatory response post-procedure.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Infectious Disease Prevention
Background:
- Peroral endoscopic myotomy (POEM) is an established treatment for achalasia.
- Gentamicin submucosal lavage was historically used in POEM to prevent infection.
- This study investigates the necessity of this practice.
Purpose of the Study:
- To evaluate the clinical significance of topical gentamicin lavage during POEM.
- To assess its impact on infectious adverse events and systemic inflammation.
Main Methods:
- Retrospective analysis of 124 patients undergoing POEM.
- Comparison of outcomes between patients receiving gentamicin lavage (Group A) and those not (Group B).
- Inclusion of systemic antibiotic prophylaxis for all patients.
Main Results:
- No significant difference in treatment success rates at 3 months between groups (94.7% vs 97.5%).
- No significant infectious adverse events reported in either group.
- Lower CRP and WBC levels observed in the gentamicin lavage group, indicating reduced inflammatory response.
Conclusions:
- Submucosal gentamicin lavage is not essential for preventing significant infections during POEM.
- Gentamicin lavage may help decrease the systemic inflammatory response after POEM.
- Further research may explore the specific benefits of reduced inflammation.
