Case 83: Peroral Endoscopic Myotomy (POEM)

  • John G. Brock-Utne


Today you are to anesthetize a 41-year-old female (5′4″, 44 Kg) for a minimally invasive procedure called peroral endoscopic myotomy (POEM). This technique has been shown to be highly effective in treating achalasia. She is otherwise healthy (ASA 2). You see her in the preoperative area and find her normotensive with an oxygen saturation (SpO2) of 100% while breathing room air.


Peroral endoscopic myotomy (POEM) GA Pneumoperitoneum Subcutaneous emphysema Peak airway pressure End-tidal CO2 


  1. 1.
    Lee E, Brodsky JB, Rivas H, Zheng K, Brock-Utne JG. Capnoperitoneum during peroral endoscopic myotomy-recognition and management: a case report. A A Case Rep. 2017;8:145–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Boeckxstaens GE, Annese V, Des Varannes BS, Chaussade S, et al. Pneumatic dilation versus laparoscopic Heller myotomy for idiopathic achalasia. N Engl J Med. 2011;364:1807–16.CrossRefPubMedGoogle Scholar
  3. 3.
    Inoue H, Minami H, Kobayashi Y, Sato Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.CrossRefPubMedGoogle Scholar
  4. 4.
    Barbieri LA, Hassan C, Rosati R, et al. Systemic review and meta-analysis: efficacy and safety of POEM for achalasia. United European Gastroenterol J. 2015;3:325–34.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Vigneswaran Y, Ujiki M. Peroral endoscopic myotomy: an emerging minimally invasive procedure for achalasia. World J Gastrointest Endosc. 2015;7(14):1129–34.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Von Rentein D, Inoue H, Minami H, Werner YB, et al. Peroral endoscopic myotomy for treatment of achalasia: a prospective single center study. Am J Gastroenterol. 2012;107:411–7.CrossRefGoogle Scholar
  7. 7.
    Tanaka E, Murata H, Minami H. Anesthetic management of peroral endoscopic myotomy for esophageal achalasia: a retrospective case series. J Anesth. 2014;28:456–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Chen SC, Lin FY, Chang KJ. Subcutaneous emphysema and pneumomediastinum after dental extraction. Am J Emerg Med. 1999;17:678–80.CrossRefPubMedGoogle Scholar
  9. 9.
    Kumar CM, Lam JF, Rao D. Unexplained hypercarbia may indicate subcutaneous emphysema during laparoscopy. Anaesth Intensive Care. 2015;43(2):272–3.PubMedGoogle Scholar
  10. 10.
    Brock-Utne JG. Case studies of near misses in clinical anesthesia. New York: Springer; 2011. p. 49–50.CrossRefGoogle Scholar
  11. 11.
    Ternlund SP, Brock-Utne JG. Failure to recognize tension pneumoperitoneum during resuscitation. Anesth Inten Care. 2006;34:517–8.Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • John G. Brock-Utne
    • 1
  1. 1.Department of AnesthesiaStanford UniversityStanfordUSA

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