Adverse Events Are Uncommon After Peroral Endoscopic Myotomy, Score Predicts Those at Risk
Prateek Sharma, MD, FASGE, reviewing Liu X, et al. Clin Gastroenterol Hepatol 2021 Apr 24.
Peroral endoscopic myotomy (POEM) is a widely accepted, effective endoscopic procedure for the management of achalasia. Although POEM is considered a relatively safe procedure, studies have reported varying rates of adverse events (AEs), ranging from mild to severe. The practice of grading AEs currently involves the use of the Clavien-Dindo classification (ranges from grade I [any deviation from the normal course] to grade V [death]) or the American Society for Gastrointestinal Endoscopy (ASGE) lexicon (ranges from mild [procedure aborted/not started, medical consult, unplanned hospitalization <3 days] to severe [prolonged intensive care unit admission, permanent disability, death]). The authors of this single-center retrospective study reported POEM-related AEs and evaluated a scoring system to predict AEs.
The study included 3135 patients (mean age, 41 years; 50% male) who had undergone POEM for achalasia. Adverse events were reported in 258 patients (8.23%). These mainly included pleural effusion (n=199), pneumothorax (n=50), delayed mucosal barrier failure (n=13), delayed bleeding (n=7), and miscellaneous AEs (n=28; inflammation, stroke, coma, etc.).
Using the Clavien-Dindo classification to grade the patients’ AEs, 175 patients (67.83%) received grade I, 23 (8.91%) grade II, 56 (21.71%) grade III, 4 (1.55%) grade IV, and 0 (0%) grade V. The same AEs were classified as mild, moderate, and severe, according to the ASGE lexicon, in 175 cases (67.83%), 66 (25.58%), and 17 (6.59%), respectively.
On multivariate analyses, air insufflation (13.39; 95% confidence interval [CI], 8.13-22.23), mucosal injury (1.8; 95% CI, 1.21-2.30), operation time of 60 minutes (2.77; 95% CI, 1.09-2.89), and selective myotomy (7.71; 95% CI, 4.70-12.63) were significantly associated with AEs. These were scored as 18, 3, 5, and 5, respectively, and incorporated into a risk calculator, which demonstrated the mean area under the curve of 0.795 in predicting POEM-related AEs. Higher scores were associated with higher risk of AEs (scores of 15-19, 9.8%; 20-24, 12.15%; 25-29, 20%; 30-34, 33.33%).
COMMENTThis study confirms that POEM is a relatively safe procedure with minimal AEs. The overall risk of complications in a high-volume center is 8%, with the majority (70%) being mild. Paying attention to certain intraprocedural events may help endoscopists to predict which patients might be at higher risk for AEs.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Liu X, Yao L, Cheng J, et al. Landscape of adverse events related to peroral endoscopic myotomy in 3135 patients and a risk-scoring system to predict major adverse events. Clin Gastroenterol Hepatol 2021 Apr 24. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2021.04.033)
