Conservative Management of Delayed Submucosal Bleeding after Per-Oral Endoscopic Myotomy: A Case Report

Area of Science:

• Gastroenterology
• Endoscopic Surgery

Background:

• Per-Oral Endoscopic Myotomy (POEM) is a primary treatment for achalasia.
• Submucosal bleeding or hematoma is a rare complication of POEM, occurring in about 1% of cases.

Purpose of the Study:

• To report a case of delayed bleeding and submucosal hematoma after POEM.
• To evaluate the efficacy of conservative management for this complication.

Main Methods:

• A patient with Type II achalasia underwent POEM.
• Delayed bleeding and submucosal hematoma developed after initiating low molecular weight heparin (LMWH).
• Conservative treatment included fasting, antibiotics, LMWH cessation, and close monitoring.

Main Results:

• The patient presented with chest pain but no active arterial bleeding.
• Urgent endoscopy was avoided.
• Complete resolution of the hematoma occurred within 10 days.

Conclusions:

• Conservative management is safe and effective for delayed submucosal hematomas post-POEM.
• This approach avoids the need for urgent endoscopic intervention in select cases.