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.
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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


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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


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