PMID- 28534521
OWN - NLM
STAT- MEDLINE
DCOM- 20170825
LR  - 20220318
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Linking)
VI  - 112
IP  - 8
DP  - 2017 Aug
TI  - Comprehensive Analysis of Adverse Events Associated With Per Oral Endoscopic 
      Myotomy in 1826 Patients: An International Multicenter Study.
PG  - 1267-1276
LID - 10.1038/ajg.2017.139 [doi]
AB  - OBJECTIVES: The safety of peroral endoscopic myotomy (POEM) is still debated 
      since comprehensive analysis of adverse events (AEs) associated with the 
      procedure in large multicenter cohort studies has not been performed. To study 
      (1) the prevalence of AEs and (2) factors associated with occurrence of AEs in 
      patients undergoing POEM. METHODS: Patients who underwent POEM at 12 
      tertiary-care centers between 2009 and 2015 were included in this case-control 
      study. Cases were defined by the occurrence of any AE related to the POEM 
      procedure. Control patients were selected for each AE case by matching for age, 
      gender, and disease classification (achalasia type I and II vs. type III/spastic 
      esophageal disorders). RESULTS: A total of 1,826 patients underwent POEM. 
      Overall, 156 AEs occurred in 137 patients (7.5%). A total of 51 (2.8%) 
      inadvertent mucosotomies occurred. Mild, moderate, and severe AEs had a frequency 
      of 116 (6.4%), 31 (1.7%), and 9 (0.5%), respectively. Multivariate analysis 
      demonstrated that sigmoid-type esophagus (odds ratio (OR) 2.28, P=0.05), 
      endoscopist experience <20 cases (OR 1.98, P=0.04), use of a triangular tip knife 
      (OR 3.22, P=0.05), and use of an electrosurgical current different than spray 
      coagulation (OR 3.09, P=0.02) were significantly associated with the occurrence 
      of AEs. CONCLUSIONS: This large study comprehensively assessed the safety of POEM 
      and highly suggests POEM as a relatively safe procedure when performed by experts 
      at tertiary centers with an overall 7.5% prevalence of AEs. Severe AEs are rare. 
      Sigmoid-type esophagus, endoscopist experience, type of knife, and current used 
      can be considered as predictive factors of AE occurrence.
FAU - Haito-Chavez, Yamile
AU  - Haito-Chavez Y
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA.
FAU - Inoue, Haruhiro
AU  - Inoue H
AD  - Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
FAU - Beard, Kristin W
AU  - Beard KW
AD  - The Oregon Clinic, Oregon, Oregon, USA.
FAU - Draganov, Peter V
AU  - Draganov PV
AD  - Division of Gastroenterology and Hepatology, University of Florida College of 
      Medicine, Gainesville, Florida, USA.
FAU - Ujiki, Michael
AU  - Ujiki M
AD  - Department of Surgery, NorthShore University Health System, Evanston, Illinois, 
      USA.
FAU - Rahden, Burkhard H A
AU  - Rahden BHA
AD  - Department of General, Visceral, Vascular and Pediatric Surgery, University 
      Medical Center, Wirzburg, Germany.
FAU - Desai, Pankaj N
AU  - Desai PN
AD  - Surat Institute of Digestive Sciences, Surat, India.
FAU - Pioche, Mathieu
AU  - Pioche M
AD  - Universite de Lyon and Hospices Civils de Lyon, Digestive Physiology, E Herriot 
      Hospital, Lyon, France.
FAU - Hayee, Bu
AU  - Hayee B
AD  - Department of Gastroenterology, King's College Hospital NHS Foundation Trust, 
      London, UK.
FAU - Haji, Amyn
AU  - Haji A
AD  - Department of Gastroenterology, King's College Hospital NHS Foundation Trust, 
      London, UK.
FAU - Saxena, Payal
AU  - Saxena P
AD  - Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, New 
      South Wales, Australia.
FAU - Reavis, Kevin
AU  - Reavis K
AD  - The Oregon Clinic, Oregon, Oregon, USA.
FAU - Onimaru, Manabu
AU  - Onimaru M
AD  - Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
FAU - Balassone, Valerio
AU  - Balassone V
AD  - Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
FAU - Nakamura, Jun
AU  - Nakamura J
AD  - Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
FAU - Hata, Yoshitaka
AU  - Hata Y
AD  - Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
FAU - Yang, Dennis
AU  - Yang D
AD  - Division of Gastroenterology and Hepatology, University of Florida College of 
      Medicine, Gainesville, Florida, USA.
FAU - Pannu, Davinderbir
AU  - Pannu D
AD  - Division of Gastroenterology and Hepatology, University of Florida College of 
      Medicine, Gainesville, Florida, USA.
FAU - Abbas, Ali
AU  - Abbas A
AD  - Division of Gastroenterology and Hepatology, University of Florida College of 
      Medicine, Gainesville, Florida, USA.
FAU - Perbtani, Yaseen B
AU  - Perbtani YB
AD  - Division of Gastroenterology and Hepatology, University of Florida College of 
      Medicine, Gainesville, Florida, USA.
FAU - Patel, Lava Y
AU  - Patel LY
AD  - Department of Surgery, NorthShore University Health System, Evanston, Illinois, 
      USA.
FAU - Filser, Jorg
AU  - Filser J
AD  - Department of General, Visceral, Vascular and Pediatric Surgery, University 
      Medical Center, Wirzburg, Germany.
FAU - Roman, Sabine
AU  - Roman S
AD  - Universite de Lyon and Hospices Civils de Lyon, Digestive Physiology, E Herriot 
      Hospital, Lyon, France.
FAU - Rivory, Jerome
AU  - Rivory J
AD  - Universite de Lyon and Hospices Civils de Lyon, Digestive Physiology, E Herriot 
      Hospital, Lyon, France.
FAU - Mion, Francois
AU  - Mion F
AD  - Universite de Lyon and Hospices Civils de Lyon, Digestive Physiology, E Herriot 
      Hospital, Lyon, France.
FAU - Ponchon, Thierry
AU  - Ponchon T
AD  - Universite de Lyon and Hospices Civils de Lyon, Digestive Physiology, E Herriot 
      Hospital, Lyon, France.
FAU - Perretta, Silvana
AU  - Perretta S
AD  - Department of Gastrointestinal and Endocrine Surgery, University of Strasbourg, 
      Strasbourg, France.
FAU - Wong, Vivien
AU  - Wong V
AD  - Department of Gastrointestinal and Endocrine Surgery, University of Strasbourg, 
      Strasbourg, France.
FAU - Maselli, Roberta
AU  - Maselli R
AD  - Gastroenterology, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, 
      Italy.
FAU - Ngamruengphong, Saowanee
AU  - Ngamruengphong S
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA.
FAU - Chen, Yen-I
AU  - Chen YI
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA.
FAU - Bukhari, Majidah
AU  - Bukhari M
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA.
FAU - Hajiyeva, Gulara
AU  - Hajiyeva G
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA.
FAU - Ismail, Amr
AU  - Ismail A
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA.
FAU - Pieratti, Renata
AU  - Pieratti R
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA.
FAU - Kumbhari, Vivek
AU  - Kumbhari V
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA.
FAU - Galdos-Cardenas, Gerson
AU  - Galdos-Cardenas G
AD  - The International Health Department-Global Disease Epidemiology and Control-The 
      Johns Hopkins School of Public Health, Baltimore, Maryland, USA.
FAU - Repici, Alessandro
AU  - Repici A
AD  - Gastroenterology, Humanitas Clinical and Research Hospital, IRCCS, Rozzano, 
      Italy.
FAU - Khashab, Mouen A
AU  - Khashab MA
AD  - Division of Gastroenterology and Hepatology, The Johns Hopkins Medical 
      Institutions, Baltimore, Maryland, USA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20170523
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
SB  - IM
MH  - Adult
MH  - Aged
MH  - Case-Control Studies
MH  - Cohort Studies
MH  - Endoscopy/*adverse effects
MH  - Esophageal Achalasia/*surgery
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*epidemiology
MH  - Treatment Outcome
EDAT- 2017/05/24 06:00
MHDA- 2017/08/26 06:00
CRDT- 2017/05/24 06:00
PHST- 2016/10/08 00:00 [received]
PHST- 2017/03/02 00:00 [accepted]
PHST- 2017/05/24 06:00 [pubmed]
PHST- 2017/08/26 06:00 [medline]
PHST- 2017/05/24 06:00 [entrez]
AID - ajg2017139 [pii]
AID - 10.1038/ajg.2017.139 [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2017 Aug;112(8):1267-1276. doi: 10.1038/ajg.2017.139. Epub 
      2017 May 23.