Abstract
Introduction
Obtaining an adequate mucosal closure is one of the crucial steps in per-oral endoscopic myotomy (POEM). Thus far, there have been no objective data comparing the various available closure techniques. This case-controlled study attempts to compare the application of endoscopic clips versus endoscopic suturing for mucosotomy closure during POEM cases.
Methods
A retrospective review of our prospective POEM database was performed. All cases in which endoscopic suturing was used to close the mucosotomy were matched to cases in which standard endoclips were used. Overall complication rate, closure time and mucosal closure costs between the two groups were compared.
Results
Both techniques offer good clinical results with good mucosal closure and the absence of postoperative leak. Closure time was significantly shorter (p = 0.044) with endoscopic clips (16 ± 12 min) when compared to endoscopic suturing (33 ± 11 min). Overall, the total closure cost analysis showed a trend toward lower cost with clips (1502 ± 849 USD) versus endoscopic suturing (2521 ± 575 USD) without reaching statistical significance (p = 0.073).
Conclusion
The use of endoscopic suturing seems to be a safe method for mucosal closure in POEM cases. Closure time is longer with suturing than conventional closure with clips, and there is a trend toward higher overall cost. Endoscopic suturing is likely most cost-effective for difficult cases where conventional closure methods fail.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Eleftheriadis N et al (2012) Training in peroral endoscopic myotomy (POEM) for esophageal achalasia. Ther Clin Risk Manag 8:329–342
Pescarus R et al (2014) Per-oral endoscopic myotomy (POEM) for esophageal achalasia. Curr Gastroenterol Rep 16(1):369
Swanstrom LL et al (2012) Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg 256(4):659–667
Sharata AM et al (2015) Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg 19(1):161–170
Khashab MA et al (2015) International multicenter experience with peroral endoscopic myotomy for the treatment of spastic esophageal disorders refractory to medical therapy (with video). Gastrointest Endosc 81(5):1170–1177
Saxena P et al (2013) An alternative method for mucosal flap closure during peroral endoscopic myotomy using an over-the-scope clipping device. Endoscopy 45(7):579–581
Ling T et al (2013) Successful use of a covered, retrievable stent to seal a ruptured mucosal flap safety valve during peroral endoscopic myotomy in a child with achalasia. Endoscopy 45(Suppl 2 UCTN):E63-4
Kurian AA et al (2013) Endoscopic suture repair of full-thickness esophagotomy during per-oral esophageal myotomy for achalasia. Surg Endosc 27(10):3910
Li H, Linghu E, Wang X (2012) Fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy (POEM). Endoscopy 44(Suppl 2 UCTN):E215-6
Funding
No external funding or grants were used for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Radu Pescarus, Eran Shlomovitz, Ahmed M. Sharata, Maria A. Cassera, Kevin M. Reavis, Christy M. Dunst and Lee L. Swanström have no conflicts of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Pescarus, R., Shlomovitz, E., Sharata, A.M. et al. Endoscopic suturing versus endoscopic clip closure of the mucosotomy during a per-oral endoscopic myotomy (POEM): a case–control study. Surg Endosc 30, 2132–2135 (2016). https://doi.org/10.1007/s00464-015-4464-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-015-4464-7