Evaluation of adverse events following peroral endoscopic myotomy (POEM) for achalasia ‒ Implications for feasibility of same-day discharge.

BACKGROUND

although hospitalization for peroral endoscopic myotomy (POEM) performance is standard practice, emerging evidence suggests it may not be essential.

OBJECTIVE

this study aimed to determine the proportion of patients eligible for same-day-discharge after POEM procedure and assess readmission rates by analyzing adverse events (AE).

METHODS

patients with achalasia who underwent POEM procedure in a single center from June 2019 to July 2023 were included. Demographic, clinical, and endoscopic data were retrospectively collected, focusing on AE within 30 days. AE were graded using the AGREE classification and events not requiring major medical intervention or suspension of the procedure were classified as incidents, whereas AE graded ≥ grade II were considered indicative of hospitalization.

RESULTS

among 76 patients, 29 (38 %) experienced at least one incident, including superficial mucosal injury (42.4 %), intraprocedural bleeding (30.3 %), bronchoaspiration (15.2 %) and pneumoperitoneum (12.1 %). Grade I AE (pain/nausea) occurred in 50 patients (65.7 %), while ten (13.2 %) had ≥ grade II AE. In the univariate analysis, bronchoaspiration and intratunnel fibrosis were associated with the development of ≥ grade II AE, but only bronchoaspiration remained significantly associated in the multivariate analysis (p = 0.007; OR 61.12, CI 95 %: 3.06-1219.86). Two patients (2.9 %) would have required readmission.

CONCLUSIONS

most of the ≥ grade II AE occur in patients undergoing POEM and can be predicted intraoperatively, suggesting that most patients could be safely discharged on the same day. Mild AE are common but are mostly managed within eight hours post-procedure, making inpatient care unnecessary. However, prospective studies are required to validate the clinical safety and practicality of this approach.