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Comprehensive Analysis of Adverse Events Associated with Gastric Peroral Endoscopic Myotomy: An International Multicenter Study

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A Correction to this article was published on 18 May 2020

This article has been updated

Abstract

Background

Gastric peroral endoscopic myotomy (G-POEM) has emerged as an effective management approach for patients with refractory gastroparesis. This study aims to comprehensively study the safety of G-POEM and describe the predictive factors of adverse events (AEs) occurrence.

Methods

This study is a retrospective study involving 13 tertiary care centers (7 USA, 1 South America, 4 Europe, and 1 Asia). Patients who underwent G-POEM for refractory gastroparesis were included. Cases were identified by the occurrence of AEs. For each case, two controls were randomly selected and matched for age (± 10 years), gender, and etiology of gastroparesis.

Results

A total of 216 patients underwent G-POEM for gastroparesis. Overall, 31 (14%) AEs were encountered [mild 24 (77%), moderate 5 (16%), and severe 2 (6%)] during the duration of the study. The most common AE was abdominal pain (n = 16), followed by mucosotomy (n = 5) and capnoperitoneum (n = 4), and AEs were most commonly identified within the first 48-h post-procedure 18 (58%). The risk of adverse event occurrence was significantly higher for endoscopists with experience of < 20 G-POEM procedures (OR 3.03 [1.03–8.94], p < 0.05).

Conclusion

G-POEM seems to be a safe intervention for refractory gastroparesis. AEs are most commonly mild and managed conservatively. Longitudinal mucosal incision, use of hook knife, use of clips for mucosal closure and endoscopist’s experience with > 20 G-POEM procedures is significantly associated with decreased incidence of AEs.

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Abbreviations

G-POEM:

Gastric peroral endoscopic myotomy

AEs:

Adverse events

ESD:

Endoscopic submucosal dissection

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Author information

Author notes

  1. Y. Ichkhanian and K. Vosoughi have contributed equally to this article.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, MD, USA

    Y. Ichkhanian, K. Vosoughi, M. Aghaie Meybodi, M. I. Itani, O. G. Brewer & M. A. Khashab

  2. Gastroenterology Department, Limoges University Hospital, 2 Avenue Martin Luther King, 87042, Rouen, France

    J. Jacques

  3. Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, NY, USA

    A. Sethi & A. A. Patel

  4. Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    A. A. Aadam & J. R. Triggs

  5. Department of Digestive Diseases & Endoscopy, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India

    A. Bapaye & S. Dorwat

  6. Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, NY, USA

    P. Benias

  7. Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    D. M. Chaves

  8. Gastroenterology Unit, Cochin University Hospital, Université Paris Descartes, Paris, France

    M. Barret

  9. Unité INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France

    M. Barret

  10. University of Michigan Health Care System, Ann Arbor, USA

    R. J. Law & N. Browers

  11. Service d’Hépato-gastro-entérologie, Hôpital Edouard Herriot, CHU Lyon, Lyon, France

    M. Pioche

  12. Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA

    P. V. Draganov

  13. Clinic of Gastroenterology, University Hospital “Alexandrovska”, Sofia, Bulgaria

    A. Kotzev & F. Estremera

  14. Division of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain

    E. Albeniz

  15. Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL, USA

    M. B. Ujiki & Z. M. Callahan

  16. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Sheikh Zayed Bldg, 1800 Orleans Street, Suite 7125G, Baltimore, MD, 21287, USA

    M. A. Khashab

Authors
  1. Y. Ichkhanian
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  2. K. Vosoughi
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  3. M. Aghaie Meybodi
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  4. J. Jacques
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  5. A. Sethi
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  6. A. A. Patel
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  7. A. A. Aadam
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  8. J. R. Triggs
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  9. A. Bapaye
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  10. S. Dorwat
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  11. P. Benias
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  12. D. M. Chaves
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  13. M. Barret
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  14. R. J. Law
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  15. N. Browers
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  16. M. Pioche
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  17. P. V. Draganov
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  18. A. Kotzev
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  19. F. Estremera
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  20. E. Albeniz
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  21. M. B. Ujiki
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  22. Z. M. Callahan
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  23. M. I. Itani
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  25. M. A. Khashab
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Corresponding author

Correspondence to M. A. Khashab.

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Disclosures

Dr. Khashab is consultant for Boston Scientific, Medtronic and Olympus. Dr. Jeremie Jacques is a consultant for Olympus and Boston Scientific. Dr. Sethi is a consultant for Boston Scientific, Olympus, and Fujifilm. Dr. Aadam is consultant for Boston Scientific. Dr. Benias is a consultant for Medtronic and Fuji Film. Dr. Chavez is consultant for Medtronic and Fuji Film. Dr. Law is consultant for Olympus America. Dr. Draganov is a consultant for Boston Scientific. Dr. Triggs is supported by NIH/NIDDK grant number T32DK101363. Dr. Ujiki is a consultant for Olympus and Boston Scientific. Dr. Ichkhanian, Dr. Vosoughi, Dr. Aghaie Meybodi, Dr. Patel, Dr. Bapaye, Dr. Dorwat, Dr. Barret, Ms. Browers, Dr. Pioche, Dr. Kotzev, Dr. Estremera, Dr. Albeniz, Dr. Callahan, Dr. Itani, and Dr. Brewer have no conflicts of interest or financial ties to disclose.

Ethical approval

IRB approval for this study across the multiple centers performed in accordance with the principles of the Declaration of Helsinki. The formal informed consent was waived.

Informed consent

The formal informed consent was waived.

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This article was updated to correct author M.I. Itani’s name in the author listing.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (MOV 20495 kb)

Video 2. Symptomatic capnoperitoneum that occurred during G-POEM and managed intraoperatively using Veress needle.

Supplementary file2 (DOCX 13 kb)

Supplementary file3 (MPG 183322 kb)

Video 1. G-POEM in 43-year-old female for treatment of refractory gastroparesis complicated by Intra-procedural duodenal mucosotomy and managed by endoscopic clipping and stent placement.

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Ichkhanian, Y., Vosoughi, K., Aghaie Meybodi, M. et al. Comprehensive Analysis of Adverse Events Associated with Gastric Peroral Endoscopic Myotomy: An International Multicenter Study. Surg Endosc 35, 1755–1764 (2021). https://doi.org/10.1007/s00464-020-07570-z

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