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This case describes the unusual adverse event of delayed bleeding and intratunnel hematoma, occurring few hours after peroral endoscopic myotomy (POEM) carried out for esophageal achalasia. The authors reopened the mucosal incision and removed clots from the tunnel using a special grasper and a snare. They then stopped active bleeding with a coagrasper and finally applied hemostatic gel. The report shows that severe adverse events may occur after POEM and all endoscopists performing submucosal procedures should be aware of them. We can draw several teaching points from this interesting case. First, if endoscopic suturing had been used instead of clips, tunnel re-entry would have been more difficult: thus, the use of clips may be considered beneficial in this regard. Second, I do not think that computed tomography (CT) is always necessary in patients with clinical signs of bleeding after POEM. Third, I found the use of hemostatic gel interesting; ideally, the authors would have added a comment on whether its use outside the lumen might carry an additional risk of adverse events. A nice case, and congratulations to the authors on its successful outcome.
Article published online:
25 May 2022
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