North American expert consensus on the post-procedural care of patients after per-oral endoscopic myotomy using a Delphi process Journal Article
| Authors: | Yang, D.; Mohammed, A.; Yadlapati, R.; Wang, A. Y.; Jeyalingam, T.; Draganov, P. V.; Gonzaga, E. R.; Hasan, M. K.; Schlachterman, A.; Xu, M. M.; Saeed, A.; Aadam, A.; Sharaiha, R. Z.; Law, R.; Wong Kee Song, L. M.; Saumoy, M.; Pandolfino, J. E.; Nishimura, M.; Kahaleh, M.; Hwang, J. H.; Bechara, R.; Konda, V. J.; DeWitt, J. M.; Kedia, P.; Kumta, N. A.; Inayat, I.; Stavropoulos, S. N.; Kumbhari, V.; Siddiqui, U. D.; Jawaid, S.; Andrawes, S.; Khashab, M.; Triggs, J. R.; Sharma, N.; Othman, M.; Sethi, A.; Baumann, A. J.; Priraka, C.; Dunst, C. M.; Wagh, M. S.; Al-Haddad, M.; Gyawali, C. P.; Kantsevoy, S.; Elmunzer, B. J. |
| Article Title: | North American expert consensus on the post-procedural care of patients after per-oral endoscopic myotomy using a Delphi process |
| Abstract: | Background & Aims: There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a consensus on several important questions on the after care of post-POEM patients through a modified Delphi process. Methods: A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management. A total of 34 experts participated in the 2 rounds of the Delphi process, with quantitative and qualitative data analyzed for each round to achieve consensus. Results: A total of 23 statements achieved a high degree of consensus. Overall, the expert panel agreed on the following: (1) same-day discharge after POEM can be considered in select patients; (2) a single dose of prophylactic antibiotics may be as effective as a short course; (3) a modified diet can be advanced as tolerated; and (4) all patients should be followed in clinic and undergo objective testing for surveillance and management of reflux. Consensus could not be achieved on the indication of post-POEM esophagram to evaluate for leak. Conclusions: The results of this Delphi process established expert agreement on several important issues and provides practical guidance on key aspects in the care of patients following POEM. © 2025 AGA Institute |
| Keywords: | postoperative care; follow up; consensus; computer assisted tomography; bleeding; esophagitis; opiate; practice guideline; coughing; dyspnea; fever; questionnaire; thorax pain; paracetamol; nausea and vomiting; delphi study; hospital admission; hospital discharge; gastroesophageal reflux; antibiotic prophylaxis; analgesia; postoperative pain; tachycardia; analgesic agent; esophagus achalasia; gastroenterologist; tachypnea; human; male; female; article; endoscopist; gastric dysmotility; likert scale; north american; delphi process; per-oral endoscopic myotomy; poem; esophagus function disorder; peroral endoscopic myotomy |
| Journal Title: | Clinical Gastroenterology and Hepatology |
| Volume: | 23 |
| Issue: | 5 |
| ISSN: | 1542-3565 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2025-04-01 |
| Start Page: | 776 |
| End Page: | 784 |
| Language: | English |
| DOI: | 10.1016/j.cgh.2024.08.024 |
| PUBMED: | 39214390 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Source: Scopus |
