Evaluation of adverse events following endoscopic peroral myotomy (POEM) for achalasia ‒ Implications for feasibility of same-day discharge.

Background: Although hospitalization for peroral endoscopic myotomy (POEM) performance is standard practice, emerging evidence suggests it may not be essential.

Objective: We aimed to determine the proportion of patients eligible for same-day-discharge after POEM procedure and assess readmission rates by analysing adverse events (AE).

Methods: Patients with achalasia who underwent POEM procedure in a single centre from June 2019 to July 2023 were included. Demographic, clinical, and endoscopic data were retrospectively collected, focusing on AE within 30 days. AE were graded using the AGREE classification and events not requiring major medical intervention or suspension of the procedure were classified as incidents, whereas AE graded  grade II were considered indicative of hospitalization.

Results: Among 76 patients, 29 (38%) experienced at least one incident, including superficial mucosal injury (42.4%), intraprocedural bleeding (30.3%), bronchoaspiration (15.2%) and pneumoperitoneum (12.1%). Grade I AE (pain/nausea) occurred in 50 patients (65.7%), while 10 (13.2%) had  grade II AE. In the univariate analysis, bronchoaspiration and intratunnel fibrosis were associated with the development of  grade II AE, but only bronchoaspiration remained significantly associated in the multivariate analysis (p=0.007; OR 61.12, CI 95% 3.06-1219.86). Two patients (2.9%) would have required readmission.

Conclusions: Most of the  grade II AE in patients undergoing POEM occur and can be predicted intraoperatively, suggesting that most patients could be safely discharged on the same day. Mild AE are common but mostly manage within 8 hours post-procedure, making inpatient care unnecessary. However, prospective studies are required to validate the clinical safety and practicality of this approach.