Abstract
Background
The aim of this study was to investigate the management and treatment for complications during and after peroral endoscopic myotomy (POEM) for patients suffering from esophageal achalasia (EA).
Methods
The data of 119 cases of EA patients who underwent POEM from October 2010 to July 2011 and the complications that arose during the operation, after the operation, and during follow-up were analyzed.
Results
Complications that occurred during the operation included cutaneous emphysema (22.7 %, 27/119) and pneumothorax (2.5 %, 3/119). Postoperative complications included pneumothorax (25.2 %, 30/119), subcutaneous emphysema (55.5 %, 66/119), mediastinal emphysema (29.4 %, 35/119), delayed hemorrhage (0.8 %, 1/119), pleural effusion (48.7 %, 58/119), minor inflammation or segmental atelectasis of the lungs (49.6 %, 59/119), and gas under diaphragm or aeroperitoneum (39.5 %, 47/119). Complications that occurred during follow-up included one case of difficulty eating caused by the stricture of mucosa and one case of dehiscence at the mouth of the tunnel created during surgery, with food retention. No deaths occurred. All complications were resolved through traditional treatment. No additional surgery was needed.
Conclusion
Complications arising during and after POEM should be treated quickly and can be resolved by using traditional treatment. POEM can be expected to become the preferred treatment for EA.
Similar content being viewed by others
References
Cheatham JG, Wong RK (2011) Current approach to the treatment of achalasia. Curr Gastroenterol Rep 13(3):219–225
Inoue H, Tianle KM, Ikeda H et al (2011) Peroral endoscopic myotomy for esophageal achalasia: technique, indication, and outcomes. Thorac Surg Clin 21(4):519–525
Li L, Zhu B, Zhou P et al (2011) New advances of the endoscopic treatment for achalasia. Chin J Dig Endosc 28(2):6–8
Swanström LL, Rieder E, Dunst CM (2011) A stepwise approach and early clinical experience in peroral endoscopic myotomy for the treatment of achalasia and esophageal motility disorders. J Am Coll Surg 213(6):751–756
Inoue H, Minami H, Kobayashi Y et al (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42(4):265–271
von Renteln D, Inoue H, Minami H et al (2012) Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol 107(3):411–417
Zhou PH, Cai MY, Yao LQ et al (2011) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Chin J Dig Endosc 28(2):4–7
Akahoshi K, Akahane H, Murata A et al (2007) Endoscopic submucosal dissection using a novel grasping type scissors forceps. Endoscopy 39:1103–1105
Acknowledgment
This study was funded by grants from the Shanghai Committee of Science and Technology (09DZ1950102, 0941196710, 10411955900, 10411969600), the National Funds of Science (81101566), and the Shanghai Health Bureau (XYQ2011017).
Disclosures
Mr. Ren Zhong, Zhong Yunshi, Zhou Pinghong, Xu Meidong, Li Liang, Shi Qiang, Yao Liqing, and Ms. Cai Mingyan have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Additional information
Z. Ren and Y. Zhong contributed equally to this work.
Rights and permissions
About this article
Cite this article
Ren, Z., Zhong, Y., Zhou, P. et al. Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc 26, 3267–3272 (2012). https://doi.org/10.1007/s00464-012-2336-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-012-2336-y