Salih Samo, Falak Hamo, Anand S Jain, Rushikesh H Shah, Vaishali Patel, Lucie F Calderon, Mengdan Xie, Parit Mekaroonkamol, Steven A Keilin, Qiang Cai
{"title":"内镜下食管肌切开术后的气体泄漏和粘膜损伤:单中心经验。","authors":"Salih Samo, Falak Hamo, Anand S Jain, Rushikesh H Shah, Vaishali Patel, Lucie F Calderon, Mengdan Xie, Parit Mekaroonkamol, Steven A Keilin, Qiang Cai","doi":"10.2147/CEG.S297338","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Peroral endoscopic myotomy (POEM) after prior myotomy (PM-POEM) can be technically challenging with possible increased adverse events. We aimed to assess gas leak and mucosal injury incidence during PM-POEM, compared to an index POEM (iPOEM), and post-procedure extubation time.</p><p><strong>Patients and methods: </strong>A retrospective study comparing PM-POEM to iPOEM from March 2016 to August 2018.</p><p><strong>Results: </strong>There were 21 subjects in the PM-POEM and 56 subjects in the iPOEM. The PM-POEM group was younger (average age 44.33 vs 57.57 years, <i>p</i>=0.0082). Gas leak incidence did not differ between groups (28.6% in PM-POEM vs 14.3% in iPOEM, <i>p</i>=0.148). For cases with imaging available postoperatively, there was a trend towards higher incidence of gas leak in the PM-POEM, but it was not statistically significant (60% vs 42.1%, <i>p</i>=0.359). The post-procedure extubation time was not different between PM-POEM and iPOEM (11.38 vs 9.46 minutes, <i>p</i>=0.93), but it was longer when gas leak occurred (15.92 vs 8.67 minutes, <i>p</i>=0.027). The odds of mucosal injury were four-fold higher (OR, 4.31; 95% CI, 1.32-14.08), and more clips were used to close mucosal injuries (0.62 vs 0.14 clips, <i>p</i>=0.0053) in the PM-POEM group. More procedures were deemed difficult or challenging in the PM-POEM (33.3% vs 7.1%, <i>p</i>=0.007). The number of clips used to close the mucosotomy was not different between groups (4.05 vs 3.84 clips, <i>p</i>=0.498). Although the myotomy was shorter in PM-POEM, it was not statistically significant (6.38 vs 7.14 cm, <i>p</i>=0.074). However, the procedure was longer in PM-POEM (61.28 vs 45.39 minutes, <i>p</i>=0.0017). There was no intervention or ICU admission required pertinent to the procedure.</p><p><strong>Conclusion: </strong>Performing PM-POEM can be more difficult with more mucosal injuries. Gas leak was associated with a slightly longer post-procedure extubation time, but clinical relevance is unclear given incidence of gas leak was unknown at time of extubation.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"173-179"},"PeriodicalIF":2.5000,"publicationDate":"2021-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/50/7a/ceg-14-173.PMC8290189.pdf","citationCount":"0","resultStr":"{\"title\":\"Gas Leak and Mucosal Injury During Endoscopic Esophageal Myotomy After Previous Myotomy: A Single-Center Experience.\",\"authors\":\"Salih Samo, Falak Hamo, Anand S Jain, Rushikesh H Shah, Vaishali Patel, Lucie F Calderon, Mengdan Xie, Parit Mekaroonkamol, Steven A Keilin, Qiang Cai\",\"doi\":\"10.2147/CEG.S297338\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Peroral endoscopic myotomy (POEM) after prior myotomy (PM-POEM) can be technically challenging with possible increased adverse events. We aimed to assess gas leak and mucosal injury incidence during PM-POEM, compared to an index POEM (iPOEM), and post-procedure extubation time.</p><p><strong>Patients and methods: </strong>A retrospective study comparing PM-POEM to iPOEM from March 2016 to August 2018.</p><p><strong>Results: </strong>There were 21 subjects in the PM-POEM and 56 subjects in the iPOEM. The PM-POEM group was younger (average age 44.33 vs 57.57 years, <i>p</i>=0.0082). Gas leak incidence did not differ between groups (28.6% in PM-POEM vs 14.3% in iPOEM, <i>p</i>=0.148). For cases with imaging available postoperatively, there was a trend towards higher incidence of gas leak in the PM-POEM, but it was not statistically significant (60% vs 42.1%, <i>p</i>=0.359). The post-procedure extubation time was not different between PM-POEM and iPOEM (11.38 vs 9.46 minutes, <i>p</i>=0.93), but it was longer when gas leak occurred (15.92 vs 8.67 minutes, <i>p</i>=0.027). The odds of mucosal injury were four-fold higher (OR, 4.31; 95% CI, 1.32-14.08), and more clips were used to close mucosal injuries (0.62 vs 0.14 clips, <i>p</i>=0.0053) in the PM-POEM group. More procedures were deemed difficult or challenging in the PM-POEM (33.3% vs 7.1%, <i>p</i>=0.007). The number of clips used to close the mucosotomy was not different between groups (4.05 vs 3.84 clips, <i>p</i>=0.498). Although the myotomy was shorter in PM-POEM, it was not statistically significant (6.38 vs 7.14 cm, <i>p</i>=0.074). However, the procedure was longer in PM-POEM (61.28 vs 45.39 minutes, <i>p</i>=0.0017). There was no intervention or ICU admission required pertinent to the procedure.</p><p><strong>Conclusion: </strong>Performing PM-POEM can be more difficult with more mucosal injuries. Gas leak was associated with a slightly longer post-procedure extubation time, but clinical relevance is unclear given incidence of gas leak was unknown at time of extubation.</p>\",\"PeriodicalId\":10208,\"journal\":{\"name\":\"Clinical and Experimental Gastroenterology\",\"volume\":\"14 \",\"pages\":\"173-179\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2021-05-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/50/7a/ceg-14-173.PMC8290189.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical and Experimental Gastroenterology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2147/CEG.S297338\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Experimental Gastroenterology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/CEG.S297338","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:在先前的肌切开术(PM-POEM)之后进行经口内窥镜肌切开术(POEM)在技术上具有挑战性，可能会增加不良事件。我们的目的是评估PM-POEM期间的气体泄漏和粘膜损伤发生率，与POEM指数(iPOEM)和术后拔管时间进行比较。患者和方法:2016年3月至2018年8月PM-POEM与iPOEM的回顾性研究。结果:PM-POEM共21例，iPOEM共56例。PM-POEM组更年轻(平均年龄44.33 vs 57.57岁，p=0.0082)。两组间气体泄漏发生率无差异(PM-POEM组为28.6%，iPOEM组为14.3%，p=0.148)。对于术后有影像学检查的病例，PM-POEM的气体泄漏发生率有升高的趋势，但差异无统计学意义(60% vs 42.1%， p=0.359)。PM-POEM与iPOEM术后拔管时间差异无统计学意义(11.38 vs 9.46 min, p=0.93)，但发生气体泄漏时拔管时间更长(15.92 vs 8.67 min, p=0.027)。粘膜损伤的几率高出4倍(OR, 4.31;95% CI, 1.32-14.08)， PM-POEM组使用更多夹子来闭合粘膜损伤(0.62 vs 0.14夹子，p=0.0053)。在PM-POEM中，更多的手术被认为是困难或具有挑战性的(33.3% vs 7.1%， p=0.007)。两组间用于关闭粘膜切开术的夹数无差异(4.05 vs 3.84夹，p=0.498)。虽然PM-POEM组的肌切开术较短，但差异无统计学意义(6.38 vs 7.14 cm, p=0.074)。然而，PM-POEM的手术时间更长(61.28分钟vs 45.39分钟，p=0.0017)。没有干预或ICU住院相关的程序要求。结论:黏膜损伤越严重，行PM-POEM越困难。气体泄漏与术后拔管时间稍长有关，但临床相关性尚不清楚，因为拔管时气体泄漏的发生率尚不清楚。
Gas Leak and Mucosal Injury During Endoscopic Esophageal Myotomy After Previous Myotomy: A Single-Center Experience.
Purpose: Peroral endoscopic myotomy (POEM) after prior myotomy (PM-POEM) can be technically challenging with possible increased adverse events. We aimed to assess gas leak and mucosal injury incidence during PM-POEM, compared to an index POEM (iPOEM), and post-procedure extubation time.
Patients and methods: A retrospective study comparing PM-POEM to iPOEM from March 2016 to August 2018.
Results: There were 21 subjects in the PM-POEM and 56 subjects in the iPOEM. The PM-POEM group was younger (average age 44.33 vs 57.57 years, p=0.0082). Gas leak incidence did not differ between groups (28.6% in PM-POEM vs 14.3% in iPOEM, p=0.148). For cases with imaging available postoperatively, there was a trend towards higher incidence of gas leak in the PM-POEM, but it was not statistically significant (60% vs 42.1%, p=0.359). The post-procedure extubation time was not different between PM-POEM and iPOEM (11.38 vs 9.46 minutes, p=0.93), but it was longer when gas leak occurred (15.92 vs 8.67 minutes, p=0.027). The odds of mucosal injury were four-fold higher (OR, 4.31; 95% CI, 1.32-14.08), and more clips were used to close mucosal injuries (0.62 vs 0.14 clips, p=0.0053) in the PM-POEM group. More procedures were deemed difficult or challenging in the PM-POEM (33.3% vs 7.1%, p=0.007). The number of clips used to close the mucosotomy was not different between groups (4.05 vs 3.84 clips, p=0.498). Although the myotomy was shorter in PM-POEM, it was not statistically significant (6.38 vs 7.14 cm, p=0.074). However, the procedure was longer in PM-POEM (61.28 vs 45.39 minutes, p=0.0017). There was no intervention or ICU admission required pertinent to the procedure.
Conclusion: Performing PM-POEM can be more difficult with more mucosal injuries. Gas leak was associated with a slightly longer post-procedure extubation time, but clinical relevance is unclear given incidence of gas leak was unknown at time of extubation.
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