Complications of submucosal endoscopy

Submucosal endoscopy essentially regroups peroral endoscopic esophageal ă myotomy (POEM) and, more recently, pyloromyotomy and tunnel tumor ă resections. The complication rate of POEM is between 5% and 10%. ă Complications include gas-related complications, mucosal tears, and ă bleeding, and are usually managed conservatively or with non-surgical ă procedures. Only one case of death has been reported. The most commonly ă identified risk factors for complicated procedures in POEM are short ă experience with the technique and sigmoid-type esophagus. The rate of ă gastro-esophageal reflux (GERD) is between 10% and 30% depending on ă the definitions, with a good clinical response to proton pump ă inhibitors. For the techniques other than POEM, the number of cases ă reported is too small to allow identification of the complications, ă which, in addition, probably vary depending on the organ involved. ă The management of gas-related complications is conservative and ă sometimes requiring percutaneous exsufflation (capnoperitoneum) or ă drainage. The endoscopic management of mucosal tears essentially ă involves clip placement and, in case of bleeding, the usual hemostasis ă techniques including stent placement. Importantly, following a rigorous ă and appropriate learning program is essential to minimize the risk of ă complications, particularly for specialists with a short experience in ă the technique. (C) 2016 Elsevier Ltd. All rights reserved.