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Published on: March 3, 2023
Mucosal Injury During Per-oral Endoscopic Myotomy: A Single-Center Experience
Abdullah Özgür Yeniova1, In Kyung Yoo2, Joo Young Cho3
1Division of Gastroenterology Tokat, Department of Internal Medicine, Tokat Gaziosmanpaşa University Faculty of Medicine, Turkey.
Background:
Peroral endoscopic myotomy is associated with a low risk of adverse events. Mucosal injury is the most common intraprocedural adverse event of peroral endoscopic myotomy. Severe mucosal injury may cause serious consequences, such as esophageal leak and mediastinitis, which affect the outcome of the procedure and prolong hospital stay. The aim of the present study was to determine the characteristics, predictors, and management approaches for unintended mucosal injury during peroral endoscopic myotomy.
Methods:
A total of 211 patients who underwent peroral endoscopic myotomy between November 2014 and June 2019 were enrolled in this study. Mucosal injury was defined according to a previous study and maintained in the endoscopy database. Patient-related and procedure-related factors were compared between patients with and without mucosal injury. Multivariate analysis was performed after adjusting for confounding factors.
Results:
A total of 206 patients were eligible for study enrollment. Of these, 44 experienced mucosal injury, with an overall frequency of 21.4% (44/206). On multivariable analysis, mucosal injury was associated with submucosal fibrosis (odds ratio, 8.33; P = .024), intraprocedural bleeding (OR, 14.29; P < .001), endoscopic diameter of 9.9 mm (OR, 4.389; P = .006), and procedure duration over 60 minutes (OR, 1.016; P = .034).
Conclusion:
Mucosal injury is a significant event encountered during peroral endoscopic myotomy, affecting its short- and long-term outcomes. Intra-procedural bleeding, endoscopic submucosal fibrosis, and use of an endoscope with a large outer diameter have been found to be significant predictors of mucosal injury. Endoscopists should pay more attention to risk factors associated with mucosal injury to avoid adverse events.
Insights
Unintended mucosal injury during peroral endoscopic myotomy (POEM) occurs in 21.4% of patients. Predictors include submucosal fibrosis, bleeding, larger endoscope diameter, and longer procedure times.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Surgical Safety
Background:
- Peroral endoscopic myotomy (POEM) is a minimally invasive procedure for esophageal motility disorders.
- Mucosal injury is the most common adverse event during POEM, potentially leading to severe complications like esophageal leaks.
- Understanding predictors of mucosal injury is crucial for improving POEM safety and outcomes.
Purpose of the Study:
- To identify the characteristics and predictors of unintended mucosal injury during POEM.
- To evaluate management strategies for mucosal injury in POEM.
Main Methods:
- A retrospective study of 206 patients who underwent POEM between November 2014 and June 2019.
- Comparison of patient-related and procedure-related factors between patients with and without mucosal injury.
- Multivariable analysis to determine independent predictors of mucosal injury.
Main Results:
- The overall incidence of mucosal injury during POEM was 21.4% (44/206 patients).
- Significant predictors of mucosal injury included submucosal fibrosis (OR, 8.33), intraprocedural bleeding (OR, 14.29), endoscope diameter of 9.9 mm (OR, 4.389), and procedure duration over 60 minutes (OR, 1.016).
Conclusions:
- Mucosal injury is a significant event impacting POEM outcomes.
- Intra-procedural bleeding, submucosal fibrosis, and larger endoscope diameter are key predictors of mucosal injury.
- Increased awareness of these risk factors can help endoscopists minimize adverse events during POEM.
