Role of postoperative endoscopy after peroral endoscopic myotomy: Evidence from a large cohort study

Table 1 Baseline characteristics, n (%)

Characteristic	Total (n = 417)
Sex
Male	230 (55.2)
Female	187 (44.8)
ASA stage
I	36 (8.6)
II	351 (84.2)
III	30 (7.2)
Autoimmune disease
None	367 (88.0)
Hashimoto	23 (5.5)
Rheumatic disease	7 (1.7)
Other	17 (4.1)
Missing value	3 (-)
Pulmonary disease
COPD	5 (1.2)
Asthma	27 (6.5)
Type 2 diabetes
NIDDM	14 (3.4)
IDDM	5 (1.2)
Smoking	84 (20.1)
Anticoagulation
None	385 (92.3)
ASS	18 (4.3)
NMH/NOAK/Warfarin	14 (3.4)
Diagnosis
Achalasia	399 (95.7)
Type I	74 (17.7)
Type II	242 (58.0)
Type III	83 (19.9)
Other	18 (4.3)
EGJ-OO	2 (0.5)
Nutcracker	1 (0.2)
Jackhammer	11 (2.6)
Other	4 (1.0)
Previous treatment
Endoscopic	126 (30.2)
Dilatation	90 (21.6)
Botox	25 (6.0)
Botox and dilatation	11 (2.6)
Myotomy	7 (1.7)

ASA: American Society of Anesthesiologists; COPD: Chronic obstructive pulmonary disease; IDDM: Insulin-dependent diabetes mellitus; NIDDM: Non-insulin-dependent diabetes mellitus; ASS: Aspirin; NMH: Heparin; NOAK: Non–vitamin K oral anticoagulant; EGJ-OO: Esophagogastric junction outflow obstruction.

Table 2 Diagnostic criteria and intraoperative characteristics

Characteristic	No.	Mean	SD
IRP in mmHg	392	30.7	11.4
DCI in mmHg/second/cm	262	3115.0	5045.0
Eckardt score	396	7.1	2.4
Dysphagia		2.7	0.7
Regurgitation		1.7	1.0
Chest pain		1.2	1.0
Weight loss		1.5	1.2
Time of surgery in minute	415	86.4	34.6
Myotomy length in cm	413	14.3	3.1
Myotomy rate in minute/cm	413	6.3	3.1

IRP: Integrated relaxation pressure; DCI: Distal contractile integral.

Table 3 Intraoperative adverse events, n (%)

Characteristic	n = 417
Patients with adverse events	42 (10.1)
Adverse events, total	48 (11.5)
Mucosal lesion, total	13 (3.1)
Esophagus	7 (1.7)
Cardia	6 (1.4)
Submucosal tunnel bleeding	16 (3.8)
Severe emphysema	9 (2.2)
Pneumothorax
Total	5 (1.2)
Requiring thoracic drain	3 (0.7)
Other	5 (1.2)
Conversion to LHM	4 (1.0)

LHM: Laparoscopic Heller myotomy.

Table 4 Postoperative morbidity, n (%)

Characteristic	n = 417
Level of care
Ward	397 (95.2)
IMC/ICU, total	20 (4.8)
IMC/ICU, procedure-related	11 (2.6)
Clavien-Dindo classification
I-II	13 (3.1)
IIIa-IVb	13 (3.1)

ICU: Intensive care unit; IMC: Intermediate care unit.

Table 5 Pathologic endoscopic findings, n (%)

Findings	Entire cohort (n = 417)	Endoscopy performed (n = 395)
No planned endoscopy	22 (5.3)
Normal findings	359 (86.1)	359 (90.9)
Pathological findings, all	36 (8.6)	36 (9.1)
Mucosal hematoma	3 (0.7)	3 (0.8)
Submucosal hematoma	8 (1.9)	8 (2.0)
Mucosal erosion/lesion	13 (3.1)	13 (3.3)
Ulcer	9 (2.2)	9 (2.3)
Insufficient closure of the entry	2 (0.5)	2 (0.5)
Active bleeding	1 (0.2)	1 (0.3)
Pathological findings, needing intervention	7 (1.7)	7 (1.8)
Endoscopic clip placement for entry closure	2 (0.5)	2 (0.5)
EVT for deep ulcer	1 (0.2)	1 (0.3)
Clip and adrenaline application	1 (0.2)	1 (0.3)
OTSC clip application for bleeding	2 (0.5)	2 (0.5)
Surgery	1 (0.2)	1 (0.3)

EVT: Endoscopic vacuum therapy; OTSC: Over-the-scope clip.