245 a retrospective analysis of adverse events of peroral endoscopic myotomy

Abstract Peroral endoscopic myotomy (POEM) has rapidly vindicated its position within the spectrum of achalasia treatment methods due to its excellent efficacy and safety. Nevertheless, POEM remains an invasive intervention which still carries risk of potential complications. The aim of our detailed analysis was to assess the perioperative and early postoperative adverse events in patients undergoing POEM at our institution. Methods We retrospectively evaluated the prospectively collected data from all consecutive patients who underwent POEM 12/2012–5/2018 at our institution and searched for periprocedural complications. Surgical classification Clavien Dindo (C-D) was used to assess the severity of adverse events. Results A total of 243 POEM procedures were performed. 73 procedures (30.0%) passed uneventfully while in 170 procedures (70.0%), 208 adverse events occurred. Minor AEs (C-D I,II) were as follows: allergic reaction to antibiotics (2/243; 0.8%), anaesthesia-related complications (14; 5.8%), pain requiring analgesics (158; 65%), fever (20; 8.2%), pneumonia (3; 1.2%) and irreversible loss of taste and smell (1; 0.4%). Major adverse events (CD III and more) included: post-POEM leak from mucosal incision requiring endoscopic clipping (5; 2.0%), pneumothorax (2; 0.8%), pleural effusion (1; 0.4%), scrotum emphysema (1; 0.4%) and death due to sudden cardiac arrest (1; 0.4%). Conclusion Minor POEM-related adverse events are rather common. Although being rare, severe complications, and even fatal, may still occur. Overall, POEM can be considered a safe procedure.