Peroral endoscopic myotomy for management of gastrointestinal motility disorder

Bypassing large submucosal vessels during peroral endoscopic myotomy reduces operative time and intraoperative blood loss in patients with achalasia

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.