Risk factors for esophageal pain after peroral endoscopic myotomy under general anesthesia: A retrospective study

Peroral endoscopic esophageal myotomy (POEM) is an innovative, minimally invasive endoscopic technique that has been widely adopted and recognized for the clinical management of achalasia because of its advantages of minimal trauma and rapid recovery. Nevertheless, clinical data have indicated that approximately 67% of patients experience esophageal pain after POEM. This high prevalence of pain not only affects patients' post-POEM recovery experience and quality of life but also presents challenges to its clinical implementation. Therefore, it is urgently necessary to explore effective intervention strategies.

To accurately determine the incidence of post-POEM pain and to comprehensively investigate the potential risk factors for the development of post-POEM pain.

In this study, 123 patients who were clinically diagnosed with achalasia and who underwent POEM were included. Baseline demographic characteristics, post-POEM numerical rating scale (NRS) pain scores, and anesthesia/surgery-related parameters were systematically collected. Patients were categorized into a pain group and a non-pain group on the basis of whether the NRS score exceeded 4 at 12 hours post-POEM. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors associated with post-POEM pain.

On the basis of the predefined inclusion and exclusion criteria, 123 eligible patients were enrolled. After adjusting for confounding factors, stepwise multivariate logistic regression analysis revealed that the preoperative Eckardt score [odds ratio (OR) = 1.317, 95% confidence interval (95%CI): 0.992-1.748, P = 0.057] and preoperative anxiety status (OR = 5.195, 95%CI: 1.691-15.959, P = 0.004) were independent risk factors for post-POEM pain. Our multifactor model exhibited robust predictive ability for postoperative pain following POEM, with an area under the receiver operating characteristic curve of 0.760 (95%CI: 0.661-0.859).

Patients with achalasia who underwent POEM presented a high prevalence of post-POEM pain, which was moderate or severe in 26.8% of these patients. After adjusting for confounding factors, multivariate analysis revealed that preoperative anxiety and a higher Eckardt score were independent risk factors for post-POEM pain.