PMID- 28987545
OWN - NLM
STAT- MEDLINE
DCOM- 20180822
LR  - 20180822
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Linking)
VI  - 87
IP  - 1
DP  - 2018 Jan
TI  - Adverse events during and after per-oral endoscopic myotomy: prevention, 
      diagnosis, and management.
PG  - 4-17
LID - S0016-5107(17)32329-5 [pii]
LID - 10.1016/j.gie.2017.09.029 [doi]
AB  - Per-oral endoscopic myotomy (POEM) has surfaced as an effective endoscopic 
      treatment modality for achalasia cardia (AC). Promising results in short- and 
      mid-term follow-up studies have increased the use of POEM for the management of 
      AC. POEM can be safely performed in an endoscopy suit, and major adverse events 
      (AEs) are uncommon. AEs encountered during POEM or during the perioperative 
      period principally include insufflation-related AEs, mucosal injuries, bleeding, 
      pain, and aspiration pneumonia. Most insufflation-related AEs do not require an 
      active intervention and therefore should not be considered as AEs in the true 
      sense. When management of AEs is required, most intraoperative AEs can be managed 
      at the same time without untoward consequences. Occurrences of AEs lessen after 
      completion of the learning curve. However, experience alone does not ensure 
      "zero" incidence of AEs, and early recognition remains essential. Postoperative 
      AEs, like leaks, delayed bleeding, and delayed mucosal perforations, may pose 
      special challenges for diagnosis and management. There is no standardized 
      classification system for grading the severity of AEs associated with POEM, 
      resulting in wide variation in their reported occurrences. Uniform reporting of 
      AEs is not only crucial to comprehensively analyze the safety of POEM but also 
      for comparison with other established treatment modalities like Heller's myotomy. 
      GERD is an important long-term AE after POEM. Unlike the perioperative AEs, 
      little is known regarding the intraoperative or patient-related factors that 
      influence the occurrence of post-POEM GERD. Large prospective studies with 
      long-term follow-up are required to determine the procedural factors associated 
      with GERD after POEM.
CI  - Copyright (c) 2018. Published by Elsevier Inc.
FAU - Nabi, Zaheer
AU  - Nabi Z
AD  - Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 
      India.
FAU - Reddy, D Nageshwar
AU  - Reddy DN
AD  - Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 
      India.
FAU - Ramchandani, Mohan
AU  - Ramchandani M
AD  - Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 
      India.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20171004
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
MH  - *Endoscopy, Digestive System
MH  - Esophageal Achalasia/*surgery
MH  - Esophageal Mucosa/*injuries
MH  - Esophageal Sphincter, Lower/*surgery
MH  - Gastroesophageal Reflux/epidemiology
MH  - Hemorrhage/epidemiology
MH  - Humans
MH  - Incidence
MH  - Intraoperative Complications/*epidemiology
MH  - Mediastinal Emphysema/epidemiology
MH  - *Myotomy
MH  - Natural Orifice Endoscopic Surgery
MH  - Pain, Postoperative/epidemiology
MH  - Pneumonia, Aspiration/epidemiology
MH  - Pneumoperitoneum/epidemiology
MH  - Pneumothorax/epidemiology
MH  - Postoperative Complications/*epidemiology
MH  - Postoperative Hemorrhage/epidemiology
MH  - Subcutaneous Emphysema/epidemiology
EDAT- 2017/10/11 06:00
MHDA- 2018/08/23 06:00
CRDT- 2017/10/09 06:00
PHST- 2017/07/24 00:00 [received]
PHST- 2017/09/20 00:00 [accepted]
PHST- 2017/10/11 06:00 [pubmed]
PHST- 2018/08/23 06:00 [medline]
PHST- 2017/10/09 06:00 [entrez]
AID - S0016-5107(17)32329-5 [pii]
AID - 10.1016/j.gie.2017.09.029 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2018 Jan;87(1):4-17. doi: 10.1016/j.gie.2017.09.029. Epub 
      2017 Oct 4.