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Updated: Nov 2, 2025
Use of the Scissor-Type Knife During the Peroral Endoscopy Myotomy Procedure for the Treatment of Achalasia
Published on: March 3, 2023
Single-dose versus short-course prophylactic antibiotics for peroral endoscopic myotomy: a randomized controlled
Roberta Maselli1, Alessandra Oliva2, Matteo Badalamenti3
1Department of Biomedical Sciences, Humanitas University, Milan, Italy; Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy.
Background And Aims:
Peroral endoscopic myotomy (POEM) has been recommended for achalasia treatment. To prevent the potential of infective risk, antibiotic prophylaxis is usually administered, whereas the additional need of antibiotic therapy after POEM is uncertain. The primary endpoint was to determine whether prophylaxis versus prophylaxis plus short therapy was needed after POEM.
Methods:
Consecutive patients scheduled for POEM were randomly assigned (1:1) to group A (prophylactic cefazolin 2 g IV) or group B (prophylaxis + cefazolin 2 g IV × 3 followed by oral amoxicillin/clavulanate 3 g/day). Infective risk was assessed by means of host response, namely body temperature and serum levels of white blood cells and C-reactive protein; immune response (the cytokines interleukin [IL]-6, IL-1β, and tumor necrosis factor-α and microbial translocation mediators lipopolysaccharide binding protein and soluble CD14); and blood cultures at time points before (t0) and after (t1, t2) POEM.
Results:
After POEM, none of the 124 enrolled patients (54.6 ± 12.6 years old; 64 men) developed any fever (body temperature: t0, 36.56± .49°C; t1, 36.53± .52°C; t2, 36.48± .41°C), without any differences between groups at any time point. Regarding systemic inflammation, no difference was reported between groups in serum levels of C-reactive protein and white blood cells. Considering microbial translocation mediated response, lipopolysaccharide binding protein (group A: t0, 1539 ± 168.6 pg/mL; t1, 1321 ± 149.1 pg/mL; t2, 2492 ± 283.2 pg/mL; group B: t0, 1318 ± 115.9 pg/mL; t1, 1492 ± 163.8 pg/mL; t2, 2600 ± 328.2 pg/mL) and soluble CD14 (group A: t0, 2.16 ± .15 μg/mL; t1, 1.89 ± .15 μg/mL; t2, 2.2 ± .15 μg/mL; group B: t0, 2.1 ± .13 μg/mL; t1, 2 ± .13 μg/mL; t2, 2.5 ± .2 μg/mL) were similar between the 2 groups; the immune response cytokines IL-6, IL-1β, and tumor necrosis factor-α also were similar in the 2 groups. In relation to blood cultures, at t1 the group B bacteremia rate was 3.2% (2/62) and group A was 1.6% (1/62) with no difference (P = .6). All subsequent blood cultures were negative at t2.
Conclusions:
According to our study, postprophylactic short-term antimicrobial therapy after POEM is not required because of a very low residual infective risk. (Clinical trial registration number: NCT03587337.).
Insights
Post-POEM antibiotic therapy is not necessary for achalasia patients. This study found no significant difference in infective risk markers between patients receiving prophylaxis alone versus prophylaxis plus short-term antibiotics, indicating low residual risk.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Infectious Disease Management
Background:
- Peroral endoscopic myotomy (POEM) is a recommended treatment for achalasia.
- Antibiotic prophylaxis is standard for POEM, but post-procedure therapy needs are unclear.
- This study investigates the necessity of additional antibiotic therapy after POEM.
Purpose of the Study:
- To determine if short-term antibiotic therapy is required after POEM in addition to prophylaxis.
- To assess infective risk by monitoring host response, immune markers, and blood cultures.
Main Methods:
- Randomized controlled trial comparing antibiotic prophylaxis alone (Group A) versus prophylaxis plus short-term oral antibiotics (Group B).
- Infective risk assessed via body temperature, white blood cells, C-reactive protein, IL-6, IL-1β, TNF-α, LBP, sCD14, and blood cultures.
- Data collected at baseline (t0) and post-procedure time points (t1, t2).
Main Results:
- No significant differences in fever, systemic inflammation markers (CRP, WBC), or immune response cytokines (IL-6, IL-1β, TNF-α) between groups.
- Microbial translocation markers (LBP, sCD14) were similar between groups.
- Blood cultures showed no significant difference in bacteremia rates (1.6% vs 3.2%), with all cultures negative at the final time point.
Conclusions:
- Postprocedural short-term antimicrobial therapy after POEM is not required.
- The residual infective risk following POEM is very low, even without extended antibiotic courses.
- Findings support current guidelines and inform clinical practice regarding antibiotic use post-POEM.
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