An evaluation of the complication risks following peroral endoscopic myotomy in patients on antithrombotic therapy
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and Other Interventional Techniques
An evaluation of the complication risks following peroral endoscopic myotomy in patients on antithrombotic therapy Sabrina Drexel1 · Katherine Bingmer1 · Mark Anderson1 · Anuja Sarode2 · Jeffrey Marks1 Received: 17 July 2020 / Accepted: 29 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Per oral endoscopic myotomy (POEM) is used to treat a variety of esophageal motility disorders and is associated with relatively few complications. However, complications in patients on antithrombotic therapy (AT) is not well-studied. We hypothesize AT patients have a higher risk of post-operative bleeding and 30-day complication rate compared to all other patients, even when these medications are held peri-operatively. Methods A single-institution retrospective review of a prospectively collected database of patients who underwent POEM procedures January 2011–July 2019 was performed. All 30-day complications were recorded, as well as management of AT medications peri-operatively. Demographic and clinical characteristics were compared using t test, Chi-Square, and Fisher’s exact test as appropriate. Multivariate logistic regression was performed to examine factors associated with post-operative complications. Results A total of 219 POEM procedures were performed. 50.2% of patients were male, and AT patients tended to be older (66.9 vs. 55.4, p = 0.01). The major complication rate was higher among AT patients (36.8% vs. 9.0%, p = 0.01), as was the rate of post-operative bleeding (10.5% vs. 1.0%, p = 0.04). After adjusting for gender and age, the use of antithrombotic therapy was significantly associated with 30-day complications (OR 6.03, p = 0.001). Conclusions Patients on AT who undergo POEM are significantly more likely to experience complications, including bleeding, within 30 days of surgery. Safe timing of post-operative resumption of antithrombotic medications remains a difficult decision that must be carefully considered by the endoscopist. Keywords POEM · Endoscopic myotomy · Bleeding · Adverse events · Antithrombotic therapy Per oral endoscopic myotomy (POEM) has now been safely performed for over a decade with approximately 10,000 procedures completed worldwide. While initially described by Inoue to treat achalasia [1], its utility has expanded to treat a variety of esophageal motility disorders, including jackhammer esophagus and diffuse esophageal spasms. Patients have excellent outcomes, on par with other surgical interventions available to treat these diseases. However, there are still several major adverse events that can occur when performing * Sabrina Drexel [email protected] 1
Department of Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA
Research in Surgical Outcomes and Effectiveness, University Hospitals Cleveland Medical Center, (UH-RISES), Cleveland, OH, USA
2
POEM, which include insufflation events, esophageal p
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