Division of Gastroenterology Tokat, Department of Internal Medicine, Tokat Gaziosmanpaşa University Faculty of Medicine, Turkey.
Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seongnam-si, Korea.
Turk J Gastroenterol. 2022 Nov;33(11):985-994. doi: 10.5152/tjg.2022.21949.
Peroral endoscopic myotomy is associated with a low risk of adverse events. Mucosal injury is the most common intraprocedural adverse event of peroral endoscopic myotomy. Severe mucosal injury may cause serious consequences, such as esophageal leak and mediastinitis, which affect the outcome of the procedure and prolong hospital stay. The aim of the present study was to determine the characteristics, predictors, and management approaches for unintended mucosal injury during peroral endoscopic myotomy.
A total of 211 patients who underwent peroral endoscopic myotomy between November 2014 and June 2019 were enrolled in this study. Mucosal injury was defined according to a previous study and maintained in the endoscopy database. Patient-related and procedure-related factors were compared between patients with and without mucosal injury. Multivariate analysis was performed after adjusting for confounding factors.
A total of 206 patients were eligible for study enrollment. Of these, 44 experienced mucosal injury, with an overall frequency of 21.4% (44/206). On multivariable analysis, mucosal injury was associated with submucosal fibrosis (odds ratio, 8.33; P = .024), intraprocedural bleeding (OR, 14.29; P < .001), endoscopic diameter of 9.9 mm (OR, 4.389; P = .006), and procedure duration over 60 minutes (OR, 1.016; P = .034).
Mucosal injury is a significant event encountered during peroral endoscopic myotomy, affecting its short- and long-term outcomes. Intra-procedural bleeding, endoscopic submucosal fibrosis, and use of an endoscope with a large outer diameter have been found to be significant predictors of mucosal injury. Endoscopists should pay more attention to risk factors associated with mucosal injury to avoid adverse events.
经口内镜下肌切开术相关的不良事件风险较低。黏膜损伤是经口内镜下肌切开术最常见的术中不良事件。严重的黏膜损伤可能会导致严重的后果，如食管漏和纵隔炎，这会影响手术的结果并延长住院时间。本研究旨在确定经口内镜下肌切开术中意外黏膜损伤的特征、预测因素和处理方法。
本研究纳入了 2014 年 11 月至 2019 年 6 月期间接受经口内镜下肌切开术的 211 例患者。根据先前的研究定义了黏膜损伤，并在内镜数据库中保留。比较了有和无黏膜损伤患者的患者相关和手术相关因素。在调整混杂因素后进行多变量分析。
共有 206 例患者符合研究纳入标准。其中，44 例发生黏膜损伤，总体发生率为 21.4%（44/206）。多变量分析显示，黏膜损伤与黏膜下纤维化（优势比，8.33；P=0.024）、术中出血（OR，14.29；P<0.001）、内镜直径 9.9mm（OR，4.389；P=0.006）和手术时间超过 60 分钟（OR，1.016；P=0.034）相关。
黏膜损伤是经口内镜下肌切开术中的一个重要事件，影响其短期和长期结果。术中出血、内镜黏膜下纤维化和使用大外径内镜已被发现是黏膜损伤的显著预测因素。内镜医师应更加注意与黏膜损伤相关的危险因素，以避免不良事件。
