The safety of peroral endoscopic myotomy is still debated since comprehensive analysis of adverse events associated with the procedure in large multicenter cohort studies has not been performed.
Dr Mouen Khashab and colleagues from Maryland, USA studied the prevalence of adverse events, and factors associated with occurrence of adverse events in patients undergoing peroral endoscopic myotomy.
Patients who underwent peroral endoscopic myotomy at 12 tertiary-care centers between 2009 and 2015 were included in this case–control study.
Cases were defined by the occurrence of any adverse event related to the peroral endoscopic myotomy procedure.
|Adverse events occurred in 8% of patients|
|American Journal of Gastroenterology|
Control patients were selected for each adverse event case by matching for age, gender, and disease classification.
A total of 1,826 patients underwent peroral endoscopic myotomy.
The research team found that adverse events occurred in 8% of patients.
The researchers noted that a total of 3% inadvertent mucosotomies occurred.
Mild, moderate, and severe adverse events had a frequency of 6%, 2%, and less than 1%, respectively.
The team demonstrated that sigmoid-type esophagus, endoscopist experience less than 20 cases, use of a triangular tip knife, and use of an electrosurgical current different than spray coagulation were significantly associated with the occurrence of adverse events.
Dr Khashab's team concludes, "This large study comprehensively assessed the safety of peroral endoscopic myotomy, and highly suggests peroral endoscopic myotomy as a relatively safe procedure when performed by experts at tertiary centers with an overall 8% prevalence of adverse events."
"Severe adverse events are rare."
"Sigmoid-type esophagus, endoscopist experience, type of knife, and current used can be considered as predictive factors of adverse events occurrence."