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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(09): E1381-E1385
DOI: 10.1055/a-1490-9385
Innovation forum

Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future

Linda Y. Zhang
Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Michael Bejjani
Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Bachir Ghandour
Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
,
Mouen A. Khashab
Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
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Abstract

Background and study aims COVID-19 has significantly impacted endoscopic assessment and management of multiple conditions. Our group recommenced treatment of highly symptomatic achalasia patients (Eckardt score ≥ 6) adopting a same-day discharge (SDD) algorithm and present early outcomes of its utilization.

Patients and methods We enrolled all outpatients undergoing POEM at a single tertiary referral center. Patients qualified for SDD if all of the following a priori criteria were met: 1) ASA grade I-III; 2) No intraprocedural adverse events (AEs); 3) Secure mucosal closure; 4) Post-procedure pain/nausea responsive to oral medications; and 5) Patients tolerating clear fluids.

Results In 17 potential SDD candidates (female 82.4 %, median age 51 years [IQR 48–64]) undergoing POEM, SDD was achieved in 14 (82.4 %). The remaining were admitted due to post-procedure pain/nausea (n = 2) and intraprocedural concerns (capnoperitoneum requiring needle decompression, n = 1). There were no post-procedure AEs or unexpected readmissions.

Conclusions This study demonstrates the safety and feasibility of a SDD algorithm for POEM patients and challenges the necessity of routine post-POEM hospital admission. Critically important during the COVID-19 pandemic, this may in fact constitute a changing standard for POEM post-procedure care.



Publication History

Received: 05 February 2021

Accepted: 31 March 2021

Article published online:
16 August 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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