Surgical endoscopy · 2026
Characteristics and predictors of technically difficult peroral endoscopic myotomy in esophageal motility disorders: a high-volume center analysis of 676 procedures.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Huang Zhen-Zi, Xiao Ying-Lian, Luo Huang-Xin, Liu Hao-Lin, Li Yuan-Qi, Tian Hong-Zhan, He Gan-Qing, Wang Jin-Hui, Cui Yi, Ding Zhen, Chen Min-Hu, Xing Xiang-Bin
Аннотация
BACKGROUND: As peroral endoscopic myotomy (POEM) indications expand, proactive identification and management of technically challenging cases are critically important. This study comprehensively evaluated characteristics, perioperative outcomes, and predictors of technically difficult POEM.
METHODS: In this retrospective cohort study (2011-2023), consecutive POEM procedures for esophageal motility disorders at a tertiary center were analyzed. Technically difficult POEM was defined as procedure time ≥ 90 min or aborted POEM. Characteristics and operation parameters were compared between the technically difficult and non-difficult groups. Weighted logistic regression, with stabilized inverse probability of treatment weighting controlled for operator- and technique-related confounders, was used to identify predictors of technically difficult POEM.
RESULTS: The final cohort included 676 POEM procedures, comprising 34 (5.0%) technically difficult POEM (3 aborted) and 642 (95.0%) non-difficult POEM. Technically difficult POEM demonstrated significantly higher hemostatic forceps utilization (79.4% vs. 48.8%), prolonged postoperative stays (4 vs. 3 days), and increased hospital costs (¥21,542 vs. ¥19,490) (P < 0.01). Clinically significant adverse events were more frequent in the technically difficult group (17.7% vs. 1.6%, P < 0.001). Weighted multivariable analysis identified prior pneumatic dilation, prior POEM, and prolonged disease duration as independent risk factors for technically difficult POEM (P < 0.05).
CONCLUSION: Technically difficult POEM was associated with higher incidence of perioperative adverse events, increased healthcare utilization, and significant financial burdens. Prior pneumatic dilation, prior POEM, and prolonged disease duration were the independent risk factors for technically difficult POEM. Centralized referral of high-risk patients to expert centers may optimize patient outcomes and enhance procedural safety.
METHODS: In this retrospective cohort study (2011-2023), consecutive POEM procedures for esophageal motility disorders at a tertiary center were analyzed. Technically difficult POEM was defined as procedure time ≥ 90 min or aborted POEM. Characteristics and operation parameters were compared between the technically difficult and non-difficult groups. Weighted logistic regression, with stabilized inverse probability of treatment weighting controlled for operator- and technique-related confounders, was used to identify predictors of technically difficult POEM.
RESULTS: The final cohort included 676 POEM procedures, comprising 34 (5.0%) technically difficult POEM (3 aborted) and 642 (95.0%) non-difficult POEM. Technically difficult POEM demonstrated significantly higher hemostatic forceps utilization (79.4% vs. 48.8%), prolonged postoperative stays (4 vs. 3 days), and increased hospital costs (¥21,542 vs. ¥19,490) (P < 0.01). Clinically significant adverse events were more frequent in the technically difficult group (17.7% vs. 1.6%, P < 0.001). Weighted multivariable analysis identified prior pneumatic dilation, prior POEM, and prolonged disease duration as independent risk factors for technically difficult POEM (P < 0.05).
CONCLUSION: Technically difficult POEM was associated with higher incidence of perioperative adverse events, increased healthcare utilization, and significant financial burdens. Prior pneumatic dilation, prior POEM, and prolonged disease duration were the independent risk factors for technically difficult POEM. Centralized referral of high-risk patients to expert centers may optimize patient outcomes and enhance procedural safety.