Abstract
Background
Per oral endoscopic myotomy (POEM) is used to treat a variety of esophageal motility disorders and is associated with relatively few complications. However, complications in patients on antithrombotic therapy (AT) is not well-studied. We hypothesize AT patients have a higher risk of post-operative bleeding and 30-day complication rate compared to all other patients, even when these medications are held peri-operatively.
Methods
A single-institution retrospective review of a prospectively collected database of patients who underwent POEM procedures January 2011–July 2019 was performed. All 30-day complications were recorded, as well as management of AT medications peri-operatively. Demographic and clinical characteristics were compared using t test, Chi-Square, and Fisher’s exact test as appropriate. Multivariate logistic regression was performed to examine factors associated with post-operative complications.
Results
A total of 219 POEM procedures were performed. 50.2% of patients were male, and AT patients tended to be older (66.9 vs. 55.4, p = 0.01). The major complication rate was higher among AT patients (36.8% vs. 9.0%, p = 0.01), as was the rate of post-operative bleeding (10.5% vs. 1.0%, p = 0.04). After adjusting for gender and age, the use of antithrombotic therapy was significantly associated with 30-day complications (OR 6.03, p = 0.001).
Conclusions
Patients on AT who undergo POEM are significantly more likely to experience complications, including bleeding, within 30 days of surgery. Safe timing of post-operative resumption of antithrombotic medications remains a difficult decision that must be carefully considered by the endoscopist.
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Acknowledgements
Study data were collected and managed using REDCap electronic data capture tools hosted at University Hospitals. It was provided free of charge courtesy of the Biomedical Informatics Core of the Clinical and Translational Science Collaborative grant (1 UL1 RR024989 from NCRR/NIH) and University Hospitals.
Funding
There was no funding associated with this study. Anuja Sarode was supported by the University Hospitals Department of Surgery Research in Surgical Outcomes and Effectiveness (UH-RISES) program.
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Dr. Marks is a consultant for Olympus and Boston Scientific. Drs. Drexel, Bingmer, and Anderson have no conflicts of interest or financial ties to disclose. Anuja Sarode has no conflicts of interest or financial ties to disclose.
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Drexel, S., Bingmer, K., Anderson, M. et al. An evaluation of the complication risks following peroral endoscopic myotomy in patients on antithrombotic therapy. Surg Endosc 35, 5620–5625 (2021). https://doi.org/10.1007/s00464-020-08065-7
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DOI: https://doi.org/10.1007/s00464-020-08065-7