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Gentamicin submucosal lavage during peroral endoscopic myotomy (POEM): a retrospective analysis

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Abstract

Background and aims

Peroral endoscopic myotomy (POEM) is an evolving therapeutic modality for achalasia. According to the original Inoue’s technique, a submucosal lavage with gentamicin has been practiced due to the fear of infection. This single-tertiary center study was intended to assess the clinical significance of the topical antibiotic lavage during POEM.

Methods

A retrospective analysis of prospectively collected data was conducted. The outcomes of patients who received the gentamicin lavage (group A) during POEM were compared to those who did not (group B). The main outcome variables were infectious adverse events, post-POEM fever, and markers of systemic inflammatory response. One day before and after POEM, all patients received systemic antibiotic prophylaxis with ceftriaxone.

Results

Of 124 consecutive patients having undergone POEM, 60 patients received a lavage with 80 mg of gentamicin into the submucosal tunnel before starting the myotomy, while 64 patients did not. The overall treatment success at 3 months did not differ between the two groups (group A 94.7 vs. 97.5% group B). We did not experience any significant infectious adverse events in either group. CRP and WBC levels were lower in patients with lavage versus those without [CRP: median 52.7 (IQR 34.9) vs. 69.5 (54.1); p = 0.01; WBCs: median 10.9 (IQR 3.3) vs. 12.6 (3.9); p < 0.01]. Post-procedural fever was present in 10% of patients in either group.

Conclusions

During POEM, the submucosal lavage with gentamicin prior to the myotomy does not play a role in the prevention of clinically significant infectious adverse events, although the systemic inflammatory response may be decreased.

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Acknowledgements

The authors would like to thank to Mrs. Jana Rauvolfova, Mrs. Gabriela Petranova, Mr. Tomas Hobza and Mr. Petr Hafner for their help and support of our POEM program.

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Authors and Affiliations

  1. Department of Hepatogastroenterology, IKEM, Videnska 1958/9, 140 21, Prague 4, Czech Republic

    Julia Bayer, Zuzana Vackova, Petr Stirand, Julius Spicak & Jan Martinek

  2. 2nd Faculty of Medicine, Charles University, Prague, Czech Republic

    Julia Bayer

  3. Department of Transplant Surgery, IKEM, Prague, Czech Republic

    Hana Svecova

  4. 1st Faculty of Medicine, Institute of Physiology, Charles University, Prague, Czech Republic

    Jan Martinek

  5. Faculty of Medicine, Ostrava University, Ostrava, Czech Republic

    Jan Martinek

Authors
  1. Julia Bayer
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  2. Zuzana Vackova
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  3. Hana Svecova
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  4. Petr Stirand
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  5. Julius Spicak
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  6. Jan Martinek
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Corresponding author

Correspondence to Jan Martinek.

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Disclosures

BS Julia Bayer, Dr. Zuzana Vackova, Dr. Hana Svecova, Dr. Petr Stirand, Prof. Julius Spicak and Assoc. Prof. Jan Martinek have no conflict of interest; no financial relationships with any pharmaceutical or device company.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Bayer, J., Vackova, Z., Svecova, H. et al. Gentamicin submucosal lavage during peroral endoscopic myotomy (POEM): a retrospective analysis. Surg Endosc 32, 300–306 (2018). https://doi.org/10.1007/s00464-017-5677-8

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  • DOI: https://doi.org/10.1007/s00464-017-5677-8

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