TY - JOUR
T1 - Safety and feasibility of performing peroral endoscopic myotomy as an outpatient procedure with same-day discharge
AU - Benias, Petros C.
AU - Korrapati, Praneet
AU - Raphael, Kara L.
AU - D'Souza, Lionel Santos
AU - Inamdar, Sumant
AU - Trindade, Arvind J.
AU - Lee, Calvin
AU - Kumbhari, Vivek
AU - Sejpal, Divyesh V.
AU - Okolo, Patrick
AU - Khashab, Mouen A.
AU - Miller, Larry
AU - Carr-Locke, David
N1 - Publisher Copyright:
© 2019 American Society for Gastrointestinal Endoscopy
PY - 2019/10
Y1 - 2019/10
N2 - Background and Aims: Peroral endoscopic myotomy (POEM) has emerged as a promising treatment option for achalasia and other foregut dysmotility disorders. However, much of the current postprocedural care, such as mandatory admission and routine esophagrams, has been adapted from current surgical practices and may not in fact be necessary. Here, we describe our algorithm and outcomes for same-day discharge. Methods: Outcomes of 103 consecutive patients who underwent POEM for achalasia and other foregut dysmotility disorders from January 2015 to December 2018 were analyzed. Patients were discharged on the same day without esophagrams following a predetermined algorithm based on procedural adverse events and postprocedural pain. Patients were closely monitored after discharge for adverse events at 24 and 48 hours and then routinely in the office setting. Results: Of the 103 POEMs, 101 were completed successfully. A total of 62.4% of patients were discharged safely on the same day, 29.7% were admitted for mild pain, and 7.9% were admitted for observation for other reasons. Overall, there were no serious adverse events at any time point. Univariate analysis identified duration of disease greater than 3 years, longer length of procedure (50.9 vs 68.5 min, P < .0001), and longer length of myotomy (7.2 vs 8.5 cm, P < .0068) as significant factors associated with postprocedural pain requiring admission. Conclusions: Although same-day discharge and foregoing routine esophagram have been suggested by many, this routine has not been systematically implemented. This series suggests that an algorithm for same-day discharge based on postprocedure chest pain and procedural complexity is both safe and feasible.
AB - Background and Aims: Peroral endoscopic myotomy (POEM) has emerged as a promising treatment option for achalasia and other foregut dysmotility disorders. However, much of the current postprocedural care, such as mandatory admission and routine esophagrams, has been adapted from current surgical practices and may not in fact be necessary. Here, we describe our algorithm and outcomes for same-day discharge. Methods: Outcomes of 103 consecutive patients who underwent POEM for achalasia and other foregut dysmotility disorders from January 2015 to December 2018 were analyzed. Patients were discharged on the same day without esophagrams following a predetermined algorithm based on procedural adverse events and postprocedural pain. Patients were closely monitored after discharge for adverse events at 24 and 48 hours and then routinely in the office setting. Results: Of the 103 POEMs, 101 were completed successfully. A total of 62.4% of patients were discharged safely on the same day, 29.7% were admitted for mild pain, and 7.9% were admitted for observation for other reasons. Overall, there were no serious adverse events at any time point. Univariate analysis identified duration of disease greater than 3 years, longer length of procedure (50.9 vs 68.5 min, P < .0001), and longer length of myotomy (7.2 vs 8.5 cm, P < .0068) as significant factors associated with postprocedural pain requiring admission. Conclusions: Although same-day discharge and foregoing routine esophagram have been suggested by many, this routine has not been systematically implemented. This series suggests that an algorithm for same-day discharge based on postprocedure chest pain and procedural complexity is both safe and feasible.
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U2 - 10.1016/j.gie.2019.04.247
DO - 10.1016/j.gie.2019.04.247
M3 - Article
C2 - 31078571
AN - SCOPUS:85067930139
SN - 0016-5107
VL - 90
SP - 570
EP - 578
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -