論文

国際誌
2020年6月16日

Importance of second-look endoscopy after per-oral endoscopic myotomy for safe postoperative management.

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society
  • Yusuke Fujiyoshi
  • ,
  • Haruhiro Inoue
  • ,
  • Mary Raina Angeli Abad
  • ,
  • Enrique Rodriguez de Santiago
  • ,
  • Yohei Nishikawa
  • ,
  • Takuki Sakaguchi
  • ,
  • Akiko Toshimori
  • ,
  • Yuto Shimamura
  • ,
  • Mayo Tanabe
  • ,
  • Kazuya Sumi
  • ,
  • Ryusuke Kimura
  • ,
  • Shinya Izawa
  • ,
  • Haruo Ikeda
  • ,
  • Manabu Onimaru

記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1111/den.13770

OBJECTIVES: Per-oral endoscopic myotomy (POEM) is a safe and effective treatment for achalasia and esophageal motility disorders. The role of second-look endoscopy (SE) on postoperative day 1 has not been examined. This study aimed to evaluate the findings and need of SE after POEM. METHODS: This is a single-center, retrospective study. All consecutive patients who underwent POEM and SE on postoperative day 1 between December 2017 and September 2019 were included. The primary endpoint was the rate of newly-detected adverse events (nAE) during SE that required endoscopic intervention or deviation from the normal postoperative course. Multivariate logistic regression was used to identify predictors of nAE. RESULTS: Four-hundred-ninety-seven patients (mean age, 50.3 years; female, 49.9%) were included. SE identified abnormal findings in a total of 71 patients (14.3%). nAE which required endoscopic intervention or deviation from the normal postoperative course were identified in 12 patients (2.4%): eight (1.6%) entry site dehiscence; two (0.4%) submucosal hemorrhage or hematoma; and two (0.4%) dehiscence of an intraoperative perforation site after endoclip closure. Other findings such as mucosal thermal damage without perforation and small submucosal hematoma were found in 54 patients (10.9%) and five patients (1.0%), respectively. Multivariate analysis showed that longer operation time and intraoperative adverse events (AE) were associated with clinically significant nAE during SE. CONCLUSIONS: Second-look endoscopy can detect and treat nAE that may lead to severe AE. Thus, SE should be highly considered before starting oral ingestion in all cases, and especially in those who present an intraoperative AE and longer operation time.

リンク情報
DOI
https://doi.org/10.1111/den.13770
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/32544261
ID情報
  • DOI : 10.1111/den.13770
  • PubMed ID : 32544261

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