An evaluation of the complication risks following peroral endoscopic myotomy in patients on antithrombotic therapy.
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.
['Drexel|Sabrina|S|', 'Bingmer|Katherine|K|', 'Anderson|Mark|M|', 'Sarode|Anuja|A|', 'Marks|Jeffrey|J|']
D004931:Esophageal Achalasia D049630:Esophageal Sphincter, Lower D004945:Esophagoscopy D005343:Fibrinolytic Agents D006801:Humans D008297:Male D000074433:Myotomy D057605:Natural Orifice Endoscopic Surgery D012189:Retrospective Studies D016896:Treatment Outcome
Endoscopic myotomy Antithrombotic therapy POEM Bleeding Adverse events