Gastrointestinal endoscopy · 2026
Blown-out myotomy after peroral endoscopic myotomy: incidence, clinical impact, and procedural factors in a large single-center cohort.
СтатьяНазвание и аннотация: Перевод в очереди
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Nishikawa Yohei, Inoue Haruhiro, Sumi Kazuya, Shigeta Kohei, Ushikubo Kei, Raymundo Nikko Theodore, Yamamoto Kazuki, Tanaka Ippei, Tanabe Mayo, Onimaru Manabu, Otsuka Koji, Ito Takayoshi, Yokoyama Noboru
Аннотация
BACKGROUND AND AIMS: Blown-out myotomy (BOM) is a pseudodiverticulum that develops at the myotomy site after peroral endoscopic myotomy (POEM) and may cause symptom recurrence. Although several reports exist, the number of studies is still limited, and many aspects, including potential risk factors, remain unclear.
METHODS: This single-center retrospective cohort study included 2427 patients who underwent POEM for achalasia-related disorders at Showa Medical University Koto Toyosu Hospital between March 2014 and March 2024. BOM was defined as a distal pseudodiverticulum with a mouth diameter >2 cm and >50% expansion of the esophageal diameter on barium esophagography. Clinical and procedural variables were compared between patients with and without BOM, and morphological characteristics were evaluated in BOM cases.
RESULTS: BOM occurred in 45 patients (1.9%). The median onset was 14 months (IQR, 6-31) after POEM. No clinically meaningful differences were found between patients with and without BOM regarding preoperative or intraoperative variables, including age, sex, body mass index, achalasia subtype, procedure time, myotomy direction, or myotomy length. Most BOMs were located on the right esophageal wall (97.8%). At the time of BOM diagnosis, 77.8% of patients had recurrent symptoms requiring additional treatment.
CONCLUSIONS: BOM is an uncommon but clinically important structural adverse event after POEM, with a low incidence of 1.9% in this large single-center cohort. Although no clear procedural risk factors were identified, and time-to-event analyses did not reveal consistent predictors, the presence of BOM was associated with worse clinical outcomes. Continued attention to procedural quality may help minimize its occurrence and improve long-term outcomes after POEM.
METHODS: This single-center retrospective cohort study included 2427 patients who underwent POEM for achalasia-related disorders at Showa Medical University Koto Toyosu Hospital between March 2014 and March 2024. BOM was defined as a distal pseudodiverticulum with a mouth diameter >2 cm and >50% expansion of the esophageal diameter on barium esophagography. Clinical and procedural variables were compared between patients with and without BOM, and morphological characteristics were evaluated in BOM cases.
RESULTS: BOM occurred in 45 patients (1.9%). The median onset was 14 months (IQR, 6-31) after POEM. No clinically meaningful differences were found between patients with and without BOM regarding preoperative or intraoperative variables, including age, sex, body mass index, achalasia subtype, procedure time, myotomy direction, or myotomy length. Most BOMs were located on the right esophageal wall (97.8%). At the time of BOM diagnosis, 77.8% of patients had recurrent symptoms requiring additional treatment.
CONCLUSIONS: BOM is an uncommon but clinically important structural adverse event after POEM, with a low incidence of 1.9% in this large single-center cohort. Although no clear procedural risk factors were identified, and time-to-event analyses did not reveal consistent predictors, the presence of BOM was associated with worse clinical outcomes. Continued attention to procedural quality may help minimize its occurrence and improve long-term outcomes after POEM.