Year 2024 / Volume 116 / Number 5
Original
Bypassing large submucosal vessels during peroral endoscopic myotomy reduces operative time and intraoperative blood loss in patients with achalasia

258-263

DOI: 10.17235/reed.2023.9974/2023

Hanghai Pan, Mengting Ren, Xinxin Zhou, Feng Ji,

Abstract
Objective: peroral endoscopic myotomy (POEM), a relatively minimally invasive endoscopic procedure, is the first-line treatment for achalasia. The aim of this study was to compare procedure-related parameters and clinical outcomes between bypassing and performing prophylactic electrocoagulation of large submucosal vessels during POEM. Methods: one hundred and twelve patients with achalasia who had undergone POEM at our hospital between April 2017 and March 2023 were retrospectively enrolled. Large submucosal vessels were bypassed to avoid injury during submucosal tunneling in the bypass group, whereas large submucosal vessels were prophylactically treated by electrocoagulation in the prophylactic electrocoagulation group. Procedure-related parameters, Eckardt score and complications were compared between the two groups. Results: the bypass group showed a significant reduction in operative time and amount of intraoperative blood loss than the prophylactic electrocoagulation group (37.11 ± 9.96 min vs 58.80 ± 17.90 min, and 1 [interquartile range: 1-2] ml vs 5 [interquartile range: 3-8] ml; p < 0.001). Eleven (17.5 %) and 44 (89.8 %) patients in the bypass and prophylactic electrocoagulation groups, respectively, required hemostatic forceps (p < 0.001). Furthermore, lower operative and hospitalization costs were recorded in the bypass group than in the prophylactic electrocoagulation group (p < 0.05). No statistically significant difference was found between the two groups in terms of submucosal tunnel length, myotomy length, clinical efficacy, or complications. Conclusions: bypassing large submucosal vessels during POEM can reduce the operative duration and intraoperative blood loss, with no difference in clinical outcomes than prophylactic electrocoagulation treatment.
Lay Summary
This study compared procedure-related parameters and clinical outcomes between bypassing and performing prophylactic electrocoagulation of large submucosal vessels during peroral endoscopic myotomy (POEM). The study included 112 patients with achalasia who had undergone POEM. In the bypass group, large submucosal vessels were bypassed to avoid injury during submucosal tunneling, whereas, in the prophylactic electrocoagulation group, large submucosal vessels were prophylactically treated by electrocoagulation. The results showed that bypassing large submucosal vessels significantly reduced intraoperative bleeding, operative duration, operative costs, and the number of patients requiring hemostatic forceps compared with performing prophylactic electrocoagulation. No statistically significant difference was found between the two groups in terms of submucosal tunnel length, myotomy length, clinical efficacy, or complications. Bypassing large submucosal vessels is technically simpler to perform with a high success rate and may be widely adopted in future clinical practice.
Share Button
New comment
Comments
No comments for this article
References
1. Khashab MA, Vela MF, Thosani N, Agrawal D, Buxbaum JL, Abbas Fehmi SM, et al. ASGE guideline on the management of achalasia. Gastrointest Endosc. 2020;91(2):213-27 e6.
2. Facciorusso A, Singh S, Abbas Fehmi SM, Annese V, Lipham J, Yadlapati R. Comparative efficacy of first-line therapeutic interventions for achalasia: a systematic review and network meta-analysis. Surg Endosc. 2021;35(8):4305-14.
3. Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020;115(9):1393-411.
4. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(4):265-71.
5. Kahrilas PJ, Katzka D, Richter JE. Clinical Practice Update: The Use of Per-Oral Endoscopic Myotomy in Achalasia: Expert Review and Best Practice Advice From the AGA Institute. Gastroenterology. 2017;153(5):1205-11.
6. Inoue H, Shiwaku H, Iwakiri K, Onimaru M, Kobayashi Y, Minami H, et al. Clinical practice guidelines for peroral endoscopic myotomy. Dig Endosc. 2018;30(5):563-79.
7. Werner YB, Hakanson B, Martinek J, Repici A, von Rahden BHA, Bredenoord AJ, et al. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med. 2019;381(23):2219-29.
8. Zhang WG, Chai NL, Zhai YQ, Linghu EQ, Li HK. Long-term outcomes of peroral endoscopic myotomy in achalasia patients with a minimum follow-up of 7 years. Chin Med J (Engl). 2020;133(8):996-8.
9. Xu S, Chai N, Tang X, Linghu E, Li L, Wang S, et al. Outcomes of peroral endoscopic myotomy in challenging achalasia patients: a long-term follow-up study. Surg Endosc. 2021;35(7):3732-43.
10. Feng Z, Liu ZM, Yuan XL, Ye LS, Wu CC, Tan QH, et al. Peroral endoscopic myotomy for management of gastrointestinal motility disorder. World J Clin Cases. 2020;8(11):2116-26.
11. Liu W, Zeng HZ, Chen HL, Wu CC, Ye LS, Hu B. Open peroral endoscopic myotomy (O-POEM) for the treatment of achalasia. Dis Esophagus. 2017;30(10):1-2.
12. Liu BR, Song JT, Omar Jan M. Video of the month. Modified peroral endoscopic myotomy. Am J Gastroenterol. 2015;110(4):499.
13. Haito-Chavez Y, Inoue H, Beard KW, Draganov PV, Ujiki M, Rahden BHA, et al. Comprehensive Analysis of Adverse Events Associated With Per Oral Endoscopic Myotomy in 1826 Patients: An International Multicenter Study. Am J Gastroenterol. 2017;112(8):1267-76.
14. Hernandez Mondragon OV, Gonzalez Martinez MA, Solorzano Pineda OM, Blancas Valencia JM, Hernandez Reyes ML. Feasibility of the peroral endoscopic myotomy (POEM) procedure with a new small-caliber endoscope (thin-POEM) in patients with achalasia. Endoscopy. 2019;51(4):350-4.
15. Li L, Chai N, Linghu E, Li Z, Du C, Zhang W, et al. Safety and efficacy of using a short tunnel versus a standard tunnel for peroral endoscopic myotomy for Ling type IIc and III achalasia: a retrospective study. Surg Endosc. 2019;33(5):1394-402.
16. Wang J, Tan N, Xiao Y, Chen J, Chen B, Ma Z, et al. Safety and efficacy of the modified peroral endoscopic myotomy with shorter myotomy for achalasia patients: a prospective study. Dis Esophagus. 2015;28(8):720-7.
17. Liu W, Zeng XH, Yuan XL, Li CH, Wu CC, Ye LS, et al. Open peroral endoscopic myotomy for the treatment of achalasia: a case series of 82 cases. Dis Esophagus. 2019;32(10):1-7.
18. Khashab MA, Benias PC, Swanstrom LL. Endoscopic Myotomy for Foregut Motility Disorders. Gastroenterology. 2018;154(7):1901-10.
Related articles

Letter

A case of achalasia associated with early esophageal cancer

DOI: 10.17235/reed.2024.10177/2023

Digestive Diseases Image

Type II achalasia with post-POEM recovery of esophageal motility

DOI: 10.17235/reed.2023.9420/2022

Letter

Infection with SARS-CoV-2 as a potential achalasia trigger

DOI: 10.17235/reed.2022.8975/2022

Digestive Diseases Image

Acute respiratory failure secondary to megaesophagus: think beyond COVID-19

DOI: 10.17235/reed.2022.8847/2022

Digestive Diseases Image

Severe drug esophagitis in a patient with achalasia

DOI: 10.17235/reed.2022.8476/2021

Digestive Diseases Image

Severe respiratory failure secondary to megaesophagus due to terminal achalasia

DOI: 10.17235/reed.2020.7672/2020

Original

Implementation of a peroral endoscopic myotomy program

DOI: 10.17235/reed.2020.7116/2020

Letter

Hypertensive panesophageal pressurization in type II achalasia

DOI: 10.17235/reed.2019.6414/2019

Letter

An unexpected cause of dysphagia: pleural mesothelioma

DOI: 10.17235/reed.2019.6024/2018

Case Report

Peroral endoscopic myotomy in pediatric jackhammer esophagus

DOI: 10.17235/reed.2018.5090/2017

Citation tools
Pan H, Ren M, Zhou X, Ji F. Bypassing large submucosal vessels during peroral endoscopic myotomy reduces operative time and intraoperative blood loss in patients with achalasia. 9974/2023


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 773 visits.
This article has been downloaded 64 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 21/09/2023

Accepted: 26/11/2023

Online First: 14/12/2023

Published: 09/05/2024

Article revision time: 64 days

Article Online First time: 84 days

Article editing time: 231 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology