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Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future

Background and study aims  COVID-19 has significantly impacted endoscopic assessment and management of multiple conditions. Our group recommenced treatment of highly symptomatic achalasia patients (Eckardt score ≥ 6) adopting a same-day discharge (SDD) algorithm and present early outcomes of its uti...

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Autores principales: Zhang, Linda Y., Bejjani, Michael, Ghandour, Bachir, Khashab, Mouen A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2021
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367444/
https://www.ncbi.nlm.nih.gov/pubmed/34466362
http://dx.doi.org/10.1055/a-1490-9385
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author Zhang, Linda Y.
Bejjani, Michael
Ghandour, Bachir
Khashab, Mouen A.
author_facet Zhang, Linda Y.
Bejjani, Michael
Ghandour, Bachir
Khashab, Mouen A.
author_sort Zhang, Linda Y.
collection PubMed
description Background and study aims  COVID-19 has significantly impacted endoscopic assessment and management of multiple conditions. Our group recommenced treatment of highly symptomatic achalasia patients (Eckardt score ≥ 6) adopting a same-day discharge (SDD) algorithm and present early outcomes of its utilization. Patients and methods  We enrolled all outpatients undergoing POEM at a single tertiary referral center. Patients qualified for SDD if all of the following a priori criteria were met: 1) ASA grade I-III; 2) No intraprocedural adverse events (AEs); 3) Secure mucosal closure; 4) Post-procedure pain/nausea responsive to oral medications; and 5) Patients tolerating clear fluids. Results  In 17 potential SDD candidates (female 82.4 %, median age 51 years [IQR 48–64]) undergoing POEM, SDD was achieved in 14 (82.4 %). The remaining were admitted due to post-procedure pain/nausea (n = 2) and intraprocedural concerns (capnoperitoneum requiring needle decompression, n = 1). There were no post-procedure AEs or unexpected readmissions. Conclusions  This study demonstrates the safety and feasibility of a SDD algorithm for POEM patients and challenges the necessity of routine post-POEM hospital admission. Critically important during the COVID-19 pandemic, this may in fact constitute a changing standard for POEM post-procedure care.
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spelling pubmed-83674442021-08-30 Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future Zhang, Linda Y. Bejjani, Michael Ghandour, Bachir Khashab, Mouen A. Endosc Int Open Background and study aims  COVID-19 has significantly impacted endoscopic assessment and management of multiple conditions. Our group recommenced treatment of highly symptomatic achalasia patients (Eckardt score ≥ 6) adopting a same-day discharge (SDD) algorithm and present early outcomes of its utilization. Patients and methods  We enrolled all outpatients undergoing POEM at a single tertiary referral center. Patients qualified for SDD if all of the following a priori criteria were met: 1) ASA grade I-III; 2) No intraprocedural adverse events (AEs); 3) Secure mucosal closure; 4) Post-procedure pain/nausea responsive to oral medications; and 5) Patients tolerating clear fluids. Results  In 17 potential SDD candidates (female 82.4 %, median age 51 years [IQR 48–64]) undergoing POEM, SDD was achieved in 14 (82.4 %). The remaining were admitted due to post-procedure pain/nausea (n = 2) and intraprocedural concerns (capnoperitoneum requiring needle decompression, n = 1). There were no post-procedure AEs or unexpected readmissions. Conclusions  This study demonstrates the safety and feasibility of a SDD algorithm for POEM patients and challenges the necessity of routine post-POEM hospital admission. Critically important during the COVID-19 pandemic, this may in fact constitute a changing standard for POEM post-procedure care. Georg Thieme Verlag KG 2021-08-16 /pmc/articles/PMC8367444/ /pubmed/34466362 http://dx.doi.org/10.1055/a-1490-9385 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Zhang, Linda Y.
Bejjani, Michael
Ghandour, Bachir
Khashab, Mouen A.
Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future
title Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future
title_full Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future
title_fullStr Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future
title_full_unstemmed Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future
title_short Rethinking the need for overnight admission after peroral endoscopic myotomy (POEM): a pandemic-driven approach to the future
title_sort rethinking the need for overnight admission after peroral endoscopic myotomy (poem): a pandemic-driven approach to the future
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367444/
https://www.ncbi.nlm.nih.gov/pubmed/34466362
http://dx.doi.org/10.1055/a-1490-9385
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