Clin Endosc.  2019 Nov;52(6):549-555. 10.5946/ce.2019.033.

Anesthetic Consideration for Peroral Endoscopic Myotomy

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea. anesthpark@chamc.ac.kr

Abstract

A recent achalasia guideline suggests that peroral endoscopic myotomy (POEM) is a safe option for achalasia that is as effective as Heller myotomy. It is recommended that POEM should be performed under general anesthesia. The incidence of adverse events such as bleeding, perforation, and carbon dioxide insufflation-related complications was lower in POEM under endotracheal general anesthesia than in POEM under sedation. Subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and accompanying hemodynamic instability can be caused by carbon dioxide insufflation. Treatment of possible physiological changes and adverse events during the POEM procedure from the point of view of anesthesiologists may give endoscopists a new perspective on improving patient safety. The territory of therapeutic endoscopy can be expanded through cooperation with other departments, including anesthesia services. Efforts to understand different perspectives will certainly help not only secure patient safety but also expand the area of treatment.

Keyword

Complication; General endotracheal anesthesia; Peroral endoscopic myotomy

MeSH Terms

Anesthesia
Anesthesia, General
Carbon Dioxide
Endoscopy
Esophageal Achalasia
Hemodynamics
Hemorrhage
Incidence
Insufflation
Mediastinal Emphysema
Patient Safety
Pneumoperitoneum
Pneumothorax
Subcutaneous Emphysema
Carbon Dioxide

Figure

  • Fig. 1. Percutaneous abdominal needle decompression. An 18-gauge angiocatheter cannula is inserted under sterile conditions at the point of right upper abdominal quadrant at least 5 cm below the rib cage after confirming that the lower edge of the liver could not be palpated. Gas in the abdominal cavity can be discharged by either syringe with negative pressure or natural drain through a fluid line using a three-way stopcock.


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