Back

P2390 - Same Day Discharge After Peroral Endoscopic Myotomy versus Overnight Observation

Tuesday, October 29

10:30 AM - 4:00 PM

Location: Exhibit Halls 3 and 4 (Street Level)

Presenting Author(s)

KD

Kara DiJoseph, DO

Hershey, Pennsylvania

Kara DiJoseph, DO¹, Carl Manzo, MD², Abraham Mathew, MD²

¹Penn State Hershey Medical Center, Hershey, PA; ²Penn State University Milton S. Hershey Medical Center, Hershey, PA

Introduction: Achalasia is a spastic motility disease of the esophagus, characterized by aperistalsis and a nonrelaxing lower esophageal sphincter. Since this disorder impacts individual’s quality of life drastically, more treatment modalities have emerged to help relieve patients’ discomfort; the most recent palliative treatment discovered being the Peroral Endoscopic Myotomy, a non-invasive procedure to alleviate hypertonicity at with the lower esophageal sphincter. With any new procedure, there is a high risk of complications including perforations and pneumothoraces that could lead to a lengthy post-operative stay. As time goes on, we are learning that this method maybe safer than we originally thought.^1,2

Methods: Utilizing the electronic medical record and with IRB approval, we analyzed 149 patients who underwent POEM procedure. Readmission rates were compared between patients who were discharged to those who were kept overnight.

Results: 149 patients underwent POEM in the study periodbetween September 23, 2013 and March 1, 2019. Same day discharge was standard in February 2017; 59 of those patients were discharged after the POEM the same day.

Discussion: POEM has been established as a very successful alternative treatment for severe achalasia that is minimally invasive compared to a surgical myotomy. It comes with many risks including pneumoperitoneum and esophageal perforation as seen in the early studies. This study effectively demonstrated the safety of same day discharge with zero people requiring readmission. In conclusion, same day discharge after a POEM is relatively safe to the general population and does not require post-operative admission for surveillance.^2,3

- Crespin, Oscar M., Louis W. C. Liu, Ambica Parmar, Timothy D. Jackson, Jemila Hamid, Eran Shlomovitz, and Allan Okrainec. “Safety and Efficacy of POEM for treatment of Achalasia: A Systematic Review of the Literature.” Surgical Endoscopy (2016)

- Ren, Zhong, Yunshi Zong, Pinghong Zhou, Meidong Xu, Mingyan Cai, Liang Li, Qiang Shi, and Liqing Yao. “Perioperative Management and Treatment for Complications during and after Peroral Endoscopic Myotomy (POEM) for Esophageal Achalasia (EA) (data from 119 Cases).” Surgical Endoscopy 11 (2012): 3267-272.

- Yang, S., M.-S. Zeng, Z.-Y Zhang, L. Liang, and X.-W. Zhang. “Pneumomediastinum and Pneumoperitoneum on Computed Tomography after Peroral Endoscopic Myotomy (POEM): Postoperative Changes or Complications?” Acta Radiologica 20(2014): 1216-221

Table 1: A subset of 149 patients was reviewed, with the average age being 58. Approximately 60 percent of patients had a hospital stay of less than 24 hours with only 5 patients stayed longer than 48 hours for issues unrelated to the prior procedure. The definition of post-procedural complication was based off a previous study, which demonstrated pneumothoraces, pneumomediastinum, and subcutaneous emphysema on imaging is likely secondary to post-operative changes.

Disclosures:

Kara DiJoseph indicated no relevant financial relationships.

Carl Manzo indicated no relevant financial relationships.

Abraham Mathew: Boston Therapeutic – Consultant.

Citation: Kara DiJoseph, DO; Carl Manzo, MD; Abraham Mathew, MD. P2390 - SAME DAY DISCHARGE AFTER PERORAL ENDOSCOPIC MYOTOMY VERSUS OVERNIGHT OBSERVATION. Program No. P2390. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.