A case of ventilatory impairment during per-oral endoscopic myotomy under general anesthesia
Takuya Okada, Shinichiro Izuta, Satoshi Mizobuchi, Takuya Okada, Shinichiro Izuta, Satoshi Mizobuchi
Abstract
ᅟ: We report a case of unexpected ventilatory impairment that occurred during per-oral endoscopic myotomy (POEM) under general anesthesia. A 73-year-old woman underwent POEM for Jackhammer esophagus. The patient developed hypercarbia, pneumoperitoneum, and severe subcutaneous emphysema during the operation. Although she was treated with abdominal paracentesis, it became difficult to ventilate her lungs a few minutes later. We recommended the surgeons to interrupt the procedure and proposed repeating the abdominal paracentesis. Simultaneously, we switched to manual ventilation and waited for the subcutaneous emphysema to subside. Thereafter, her respiratory status gradually improved and the surgeons were able to continue the operation. We considered that the main reason for our patient's severe ventilatory impairment was that the length of surgical dissection was longer than usual.
Keywords: Gas-related complication; Jackhammer esophagus; Per-oral endoscopic myotomy; Ventilatory impairment.
Conflict of interest statement
The authors declare that they have no competing interests.
References
- Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Okada N, Itoh H, Kudo S. Per-oral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–271. doi: 10.1055/s-0029-1244080.
- Bhayani NH, Kurian AA, Dunst CM, Sharata AM, Rieder E, Swanstorm LL. A comparative study on comprehensive, objective outcomes of laparoscopic heller myotomy with per-oral endoscopic myotomy (POEM) for achalasia. Ann Surg. 2014;259:1098–1103. doi: 10.1097/SLA.0000000000000268.
- Bechara E, Ikeda H, Inoue H. Peroral endoscopic myotomy for jackhammer esophagus: to cut or not to cut the lower esophageal sphincter. Endosc Int Open. 2016;4:E585–E588. doi: 10.1055/s-0042-105204.
- Lee E, Brodsky JB, Rivas H, Zheng K, Brock-Utne JG. Capnoperitoneum during peroral endoscopic myotomy-recognition and management: a case report. A A Case Rep. 2017;8:145–146. doi: 10.1213/XAA.0000000000000449.
- Ren Z, Zhong Y, Zhou P, Xu M, Cai M, Li L, Shi Q, Yao L. Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases) Surg Endosc. 2012;26:3267–3272. doi: 10.1007/s00464-012-2336-y.
- Patel K, Abbassi-Ghadi N, Markar S, Kumar S, Jethwa P, Zaninotto G. Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis. Dis Esophagus. 2016;29:807–819. doi: 10.1111/dote.12387.
- Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, Yokomichi H, Kobayashi Y, Grimes KL, Kudo SE. Per-oral endoscopic myotomy: a series of 500 patients. J Am Coll Surg. 2015;221:256–264. doi: 10.1016/j.jamcollsurg.2015.03.057.
Source: PubMed