Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2018; 10(9): 193-199
Published online Sep 16, 2018. doi: 10.4253/wjge.v10.i9.193
Anesthetic management and associated complications of peroral endoscopic myotomy: A case series
Yuuki Nishihara, Takuya Yoshida, Mayu Ooi, Norihiko Obata, Shinichiro Izuta, Satoshi Mizobuchi
Yuuki Nishihara, Takuya Yoshida, Mayu Ooi, Norihiko Obata, Shinichiro Izuta, Department of Anesthesiology, Kobe University Hospital, Kobe 650-0017, Japan
Satoshi Mizobuchi, Division of Anesthesiology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
Author contributions: Nishihara Y, Yoshida T and Obata N designed research; Nishihara Y and Yoshida T collected data and drafted the manuscript; Ooi M, Izuta S and Mizobuchi S revised the manuscript for important intellectual content; Mizobuchi S supervised the study; all authors have read and approved the final version to be published.
Institutional review board statement: This study was reviewed and approved by Kobe University Hospital institutional Review Board.
Informed consent statement: All study participants provided informed written consent prior to study enrollment. The patients can share their perspective on their cases.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Takuya Yoshida, MD, Doctor, Department of Anesthesiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. takuyayoshida47@gmail.com
Telephone: +81-78-3826172 Fax: +81-78-3826189
Received: May 2, 2018
Peer-review started: May 3, 2018
First decision: May 22, 2018
Revised: May 27, 2018
Accepted: June 30, 2018
Article in press: June 30, 2018
Published online: September 16, 2018
Processing time: 139 Days and 8.8 Hours
ARTICLE HIGHLIGHTS
Research background

Peroral endoscopic myotomy (POEM) is a novel procedure that has become established as the best treatment option for esophageal achalasia, as POEM is safer and less invasive than other surgery, and is expected to offer long-lasting symptom control. While POEM is performed under general anesthesia, few reports exist about its anesthetic management, particularly regarding anesthetic complications.

Research motivation

Fatal anesthetic complications sometimes occurred during POEM, but few reports exist about them. Hence, we describe here the anesthetic management and associated complications in 86 patients who underwent POEM for esophageal achalasia at our institution.

Research objectives

We describe here the anesthetic management and associated complications in 86 patients who underwent POEM for esophageal achalasia at our institution.

Research methods

This study was a single-center, retrospective, observational study comprising a case series of all patients who underwent POEM in our hospital from April 2015 to November 2016. We collected data regarding patient characteristics, anesthetic methods, surgical factors, and complications using an electronic chart.

Research results

There were 86 patients who underwent POEM in our hospital during the study period. There was one case of aspiration (1.2%). In three cases, the peak airway pressure exceeded 35 cmH2O during volume controlled ventilation with tidal volumes of 6-8 mL/kg and subsequent impairment of ventilation. These cases had been diagnosed with spastic esophageal disorders (SEDs) and the length of the muscular incision on the esophageal side was longer than normal.

Research conclusions

Our report is the first one describing ventilatory impairment during POEM. In the anesthetic management of POEM, it is important to identify and treat complications associated with CO2 insufflation. In particular, pneumoperitoneum needs to be carefully assessed for during the procedure, especially when a longer muscular incision on the esophageal side is necessary.

Research perspectives

Because POEM allows for a longer length of muscular incision on the esophageal side, POEM is more useful than laparoscopic Heller operation for SEDs, and may become first-line treatment for SEDs in the future. We speculated that the longer incision length led to massive leakage of CO2 into the mediastinum. In this regard, a future prospective study should be conducted about complications associated with CO2 insufflation in POEM for SEDs.