Bypassing large submucosal vessels during peroral endoscopic myotomy reduces operative time and intraoperative blood loss in patients with achalasia.

ABSTRACT

OBJECTIVE: Peroral endoscopic myotomy (POEM), a relatively, minimally invasive endoscopic procedure, is the first-line treatment for achalasia. The aim of this study is to compare procedure-related parameters and clinical outcomes between bypassing and performing prophylactic electrocoagulation of large submucosal vessels during POEM. METHODS: We retrospectively enrolled 112 patients with achalasia who had undergone POEM at our hospital between April 2017 and March 2023. Large submucosal vessels were bypassed to avoid injury during submucosal tunneling in the bypass group; whereas, large submucosal vessels were prophylactically treated by electrocoagulation in prophylactic electrocoagulation group. Procedure-related parameters, Eckardt score, and complications were compared between the two groups. RESULTS: The bypass group showed a significant reduction in the operative time and amount of intraoperative blood loss than prophylactic electrocoagulation group (37.11 ± 9.96 min vs. 58.80 ± 17.90 min, and 1 [interquartile range 1-2] mL vs. 5 [interquartile range 3-8] mL; P < 0.001). Eleven (17.5%) and 44 (89.8%) patients in the bypass and prophylactic electrocoagulation groups, respectively, required hemostatic forceps (P < 0.001). Furthermore, lower operative and hospitalization costs were recorded in the bypass group than those in prophylactic electrocoagulation group (P < 0.05). No statistically significant difference was found between the two groups in terms of submucosal tunnel length, myotomy length, clinical efficacy, or complications. CONCLUSIONS: Bypassing large submucosal vessels during POEM can reduce the operative duration and intraoperative blood loss, with no difference in clinical outcomes than the prophylactic electrocoagulation treatment.