INTRAOPERATIVE COMPLICATIONS OF PERORAL ENDOSCOPIC MYOTOMY (POEM)

Aims:

To show most frequent Intraoperative complications of Endoscopic Myotomy and methods of their correction.

Methods:

Over the period of 2014 – 2017, 80 patients have undergone Peroral Endoscopic Myotomy at the Department of General Surgery with Endoscopy Course of Saint Petersburg State Pediatric Medical University at the premises of Saint Petersburg State Budget Healthcare Institution “Municipal Mariinskaya Hospital”. Among them 7 patients had hypercapnia, 5 patients had tense carboxyperitoneum, 3 patients had a hemorrhage at myotomy, 2 patients had a perforation of mucosa in the area of esophagogastric junction and one patient had problems with clipping of an entry to the submucosal layer because of intense edema because of long-term inflammation process

Results:

Hypercapnia was eliminated by additional anesthesiological measures in the form of hyperventilation, increase in minute ventilation, increase in oxygen percentage in the inspired gas mixture and cutting-off the carbon dioxide. Carboxyperitoneum was eliminated by the way of abdominal paracentesis using Veress needle during the surgery. Hemostasis in case of hemorrhage from divided circular muscles and damaged perforating arteries was made by Coagrasper FD-410LR disposable electrosurgical hemostatic forceps. Perforation of mucosa was closed using “Olympus” HX-610 – 135L endoscopic clips. Suturing of an entry to the submucosal layer in a patient was made using Boston Scientific clips with multiple re-opening opportunity. So, all the complications of Peroral Endoscopic Myotomy that we had, were corrected in time, at the surgery and without any extensive surgical interventions.

Conclusions:

All patients from early to advanced stages of esophageal achalasia have shown significant clinical improvement according to MOS SF 36 questionnaire. Obviously that the method of Peroral Endoscopic Myotomy is a new pathogenetically-based, highly effective and – in case of temporary eliminations of intraoperative complications – the most safe method for patients with esophageal achalasia.