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Same-day discharge is safe and feasible following POEM surgery for esophageal motility disorders

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Abstract

Introduction

Per-oral endoscopic myotomy (POEM) is an effective treatment for achalasia and other esophageal dysmotility disorders. Current practices surrounding post-operative care involve admission and routine esophagogram prior to discharge. This study aims to establish the safety and feasibility of same-day discharge following POEM.

Methods

Retrospective analysis of prospectively collected data for patients who underwent POEM between November 2013 and June 2019 at a single institution in Ontario, Canada. Patients were discharged home on the same day with controlled pain, when tolerating clear fluids. Patients were admitted if clinically indicated. Esophagography was initially a systematic practice prior to discharge, but later only performed when clinically indicated. Emergency department visits and hospital admissions within 90 days were assessed.

Results

In total, 90 patients underwent a successful POEM procedure. A total of 72 patients (79.1%) were discharged on the same day, 14 patients (15.4%) were discharged home the following day, and 5 patients (5.5%) experienced longer admissions to hospital. One POEM was unsuccessful. 22 (24.2%) patients had adverse events, leading to 8 (8.8%) unplanned admissions, with one patient requiring prolonged admission for esophageal leak, identified clinically. Fifty-three patients underwent routine esophagography while part of our protocol, with no identified leak, which prompted our change in practice to only perform esophagography when clinically indicated. In the 90-day post-procedure, ten patients visited the emergency department, of which seven were re-admitted, five for POEM-related issues. Our mean Eckhardt score at 2 weeks was 2.1 from 7.2 preoperatively.

Conclusion

This study establishes that same-day discharge is both safe and feasible following POEM and suggests that esophagography should be performed only when clinically indicated. This represents a shift from the routine practice of admission and imaging for patients undergoing POEM, encouraging the transition to outpatient POEM procedures.

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Authors and Affiliations

  1. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Zacharie Cloutier, Aneetinder Mann, Aristithes G. Doumouras & Dennis Hong

  2. Division of General Surgery, St. Joseph’s Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada

    Aristithes G. Doumouras & Dennis Hong

Authors
  1. Zacharie Cloutier
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  2. Aneetinder Mann
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  3. Aristithes G. Doumouras
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  4. Dennis Hong
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Correspondence to Dennis Hong.

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Drs. Cloutier, Mann, Doumouras, and Hong have no conflicts of interest or financial ties to disclose.

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Cloutier, Z., Mann, A., Doumouras, A.G. et al. Same-day discharge is safe and feasible following POEM surgery for esophageal motility disorders. Surg Endosc 35, 3398–3404 (2021). https://doi.org/10.1007/s00464-020-07781-4

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  • DOI: https://doi.org/10.1007/s00464-020-07781-4

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