PMID- 36171448 OWN - NLM STAT- MEDLINE DCOM- 20230224 LR - 20230510 IS - 1432-2218 (Electronic) IS - 0930-2794 (Linking) VI - 37 IP - 2 DP - 2023 Feb TI - Periprocedural safety profile of peroral endoscopic myotomy (POEM)-a retrospective analysis of adverse events according to two different classifications. PG - 1242-1251 LID - 10.1007/s00464-022-09621-z [doi] AB - BACKGROUND: Peroral endoscopic myotomy (POEM) is nowadays a standard method for treatment of achalasia; nevertheless, it remains an invasive intervention with corresponding risk of adverse events (AEs). The classification and grading of AEs are still a matter of discussion. The aim of our retrospective study was to assess the occurrence of all "undesirable" events and "true" adverse events in patients undergoing POEM and to compare the outcomes when either Clavien-Dindo classification (CDC) or American Society of Gastrointestinal Endoscopy (ASGE) lexicon classification applied. METHODS: This was a retrospective analysis of prospectively managed database of all patients who had undergone POEM between December 2012 and August 2018. We assessed the pre-, peri-, and early-postoperative (up to patient's discharge) undesirable events (including those not fulfilling criteria for AEs) and "true" AEs according the definition in either of the classifications. RESULTS: A total of 231 patients have successfully undergone 244 POEM procedures (13 x re-POEM). Twenty-nine procedures (11.9%) passed uneventfully, while in 215 procedures (88.1%), a total of 440 undesirable events occurred. The CDC identified 27 AEs (17 minor, 10 major) occurring in 23/244 (9.4%) procedures. The ASGE lexicon identified identical 27 AEs (21 mild or moderate, 6 severe or fatal) resulting in the severity distribution of AEs being the only difference between the two classifications. Only the absence of previous treatment was found to be a risk factor [p = 0.047, OR with 95% CI: 4.55 (1.02; 20.25)] in the combined logistic regression model. CONCLUSION: Undesirable events are common in patients undergoing POEM but the incidence of true AEs is low according to both classifications. Severe adverse events are infrequent irrespective of the classification applied. CDC may be more appropriate than ASGE lexicon for classifying POEM-related AEs given a surgical nature of this procedure. CI - (c) 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. FAU - Simkova, Dagmar AU - Simkova D AUID- ORCID: 0000-0001-9233-0602 AD - Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic. FAU - Mares, Jan AU - Mares J AUID- ORCID: 0000-0002-4727-3685 AD - Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic. FAU - Vackova, Zuzana AU - Vackova Z AUID- ORCID: 0000-0002-0443-5752 AD - Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic. FAU - Hucl, Tomas AU - Hucl T AUID- ORCID: 0000-0002-5648-4011 AD - Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic. FAU - Stirand, Petr AU - Stirand P AD - Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic. FAU - Kieslichova, Eva AU - Kieslichova E AUID- ORCID: 0000-0002-3930-623X AD - Department of Anesthesiology and Intensive Care, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague, Czech Republic. FAU - Ryska, Ondrej AU - Ryska O AUID- ORCID: 0000-0002-0438-895X AD - Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK. FAU - Spicak, Julius AU - Spicak J AUID- ORCID: 0000-0002-3823-2881 AD - Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic. FAU - Drazilova, Sylvia AU - Drazilova S AUID- ORCID: 0000-0003-2448-6757 AD - 2Nd Department of Internal Medicine, PJ Safarik University and L. Pasteur University Hospital, Trieda SNP 1, 040 11, Kosice, Slovakia. FAU - Veseliny, Eduard AU - Veseliny E AUID- ORCID: 0000-0001-8256-7470 AD - 2Nd Department of Internal Medicine, PJ Safarik University and L. Pasteur University Hospital, Trieda SNP 1, 040 11, Kosice, Slovakia. FAU - Martinek, Jan AU - Martinek J AUID- ORCID: 0000-0002-1415-4719 AD - Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine IKEM, Videnska 1921, 140 21, Prague 4, Czech Republic. jan.martinek@volny.cz. AD - Institute of Physiology, 1St Faculty of Medicine, Charles University, Prague, Czech Republic. jan.martinek@volny.cz. AD - Faculty of Medicine, Ostrava University, Ostrava, Czech Republic. jan.martinek@volny.cz. LA - eng PT - Journal Article DEP - 20220928 PL - Germany TA - Surg Endosc JT - Surgical endoscopy JID - 8806653 SB - IM MH - Humans MH - Retrospective Studies MH - *Esophageal Achalasia/surgery MH - *Digestive System Surgical Procedures MH - Risk Factors MH - *Myotomy/methods MH - *Natural Orifice Endoscopic Surgery/methods MH - Treatment Outcome MH - Esophageal Sphincter, Lower/surgery OTO - NOTNLM OT - Achalasia OT - Adverse events OT - Peroral endoscopic myotomy EDAT- 2022/09/29 06:00 MHDA- 2023/02/25 06:00 CRDT- 2022/09/28 23:35 PHST- 2021/12/06 00:00 [received] PHST- 2022/09/11 00:00 [accepted] PHST- 2022/09/29 06:00 [pubmed] PHST- 2023/02/25 06:00 [medline] PHST- 2022/09/28 23:35 [entrez] AID - 10.1007/s00464-022-09621-z [pii] AID - 10.1007/s00464-022-09621-z [doi] PST - ppublish SO - Surg Endosc. 2023 Feb;37(2):1242-1251. doi: 10.1007/s00464-022-09621-z. Epub 2022 Sep 28.