Periprocedurálne komplikácie POEM

Abstract

Introduction : Achalasia is a primary rare esophageal motility disorder characterized by the aperistalsis with concomitant abscence of relaxation of lower esophageal sphincter. A significant advance in treatment was the introduction of a new technique -peroral endoscopic myotomy (POEM). In this work, we decided to focus on the periprocedural complications of POEM in our patients. Methods: Retrospectively, we evaluated the incidence of periprocedural complications in patients with esophageal achalasia who had undergone POEM. Results: Of the total number of 136 patients, 132 patients received POEM successfully. In most patients was performed POEM anterior (n = 109), POEM posterior was performed in 23 patients. A total of 50 patients (38%) experienced some type of complication during surgery. The most frequent complication was thermal damage of the mucosa (27.3%). The second most common complication was capnoperitoneum (14%). Severe capnoperitoneum was present in 5 patients (3.8%). Subcutaneous emphysema was observed in 6 patients (4.5%). Seven patients (6%) experienced periprocedural perforation. Of all the complications, two required subsequent surggical treatment. There was no performance-related death in our patient population. Conclusion and discussion: POEM is a worldwide accepted therapy for achalasia. It is generally considered to be a safe method with low incidence of serious adverse complications. Data on the incidence of peroperative complications vary, particularly in what is considered to be a complication and what is a normal part of surgery. However, the important fact remains that severe life-threatening complications are rare.