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. 2021 May 20:14:173-179.
doi: 10.2147/CEG.S297338. eCollection 2021.

Gas Leak and Mucosal Injury During Endoscopic Esophageal Myotomy After Previous Myotomy: A Single-Center Experience

Salih Samo  1   2 , Falak Hamo  2 , Anand S Jain  1 , Rushikesh H Shah  1 , Vaishali Patel  1 , Lucie F Calderon  1 , Mengdan Xie  1 , Parit Mekaroonkamol  1 , Steven A Keilin  1 , Qiang Cai  1
Affiliations

Gas Leak and Mucosal Injury During Endoscopic Esophageal Myotomy After Previous Myotomy: A Single-Center Experience

Salih Samo et al. Clin Exp Gastroenterol. .

Abstract

Purpose: Peroral endoscopic myotomy (POEM) after prior myotomy (PM-POEM) can be technically challenging with possible increased adverse events. We aimed to assess gas leak and mucosal injury incidence during PM-POEM, compared to an index POEM (iPOEM), and post-procedure extubation time.

Patients and methods: A retrospective study comparing PM-POEM to iPOEM from March 2016 to August 2018.

Results: There were 21 subjects in the PM-POEM and 56 subjects in the iPOEM. The PM-POEM group was younger (average age 44.33 vs 57.57 years, p=0.0082). Gas leak incidence did not differ between groups (28.6% in PM-POEM vs 14.3% in iPOEM, p=0.148). For cases with imaging available postoperatively, there was a trend towards higher incidence of gas leak in the PM-POEM, but it was not statistically significant (60% vs 42.1%, p=0.359). The post-procedure extubation time was not different between PM-POEM and iPOEM (11.38 vs 9.46 minutes, p=0.93), but it was longer when gas leak occurred (15.92 vs 8.67 minutes, p=0.027). The odds of mucosal injury were four-fold higher (OR, 4.31; 95% CI, 1.32-14.08), and more clips were used to close mucosal injuries (0.62 vs 0.14 clips, p=0.0053) in the PM-POEM group. More procedures were deemed difficult or challenging in the PM-POEM (33.3% vs 7.1%, p=0.007). The number of clips used to close the mucosotomy was not different between groups (4.05 vs 3.84 clips, p=0.498). Although the myotomy was shorter in PM-POEM, it was not statistically significant (6.38 vs 7.14 cm, p=0.074). However, the procedure was longer in PM-POEM (61.28 vs 45.39 minutes, p=0.0017). There was no intervention or ICU admission required pertinent to the procedure.

Conclusion: Performing PM-POEM can be more difficult with more mucosal injuries. Gas leak was associated with a slightly longer post-procedure extubation time, but clinical relevance is unclear given incidence of gas leak was unknown at time of extubation.

Keywords: Heller’s myotomy; achalasia; gas leak; mucosal injury; peroral endoscopic myotomy.

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Conflict of interest statement

None of the authors has conflict of interest or financial ties to disclose.

Figures

Figure 1
Figure 1
Extubation time based on gas leak status.
See this image and copyright information in PMC

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