P0633 - Pre-POEM Endoscopic Work Up; Comparison of General Anesthesia and Monitored Anesthesia Care on Patient Outcomes

MUHAMMAD H. BASHIR, MD¹, Umma K. Fatema, ², Vincent Del Duca, ³, Divya Chalikonda, MD⁴, Mario Gonzalez, MD¹, Alex Schlachterman, MD^1
1Thomas Jefferson University Hospital, Philadelphia, PA; ²Thomas Jefferson Medical School, Phiadelphia, PA; ³Thomas Jefferson University, Philadelphia, PA; ⁴Thomas Jefferson University Hospitals, Philadelphia, PA

Introduction: Esophagogastroduodenoscopy (EGD), Endoscopic Ultrasound (EUS) and EndoFLIP™ Impedance Planimetry are performed as a part of pre-POEM work up to determine the necessity, safety and procedure planning. Risk of aspiration is higher in achalasia patients due to likelihood of retained food and fluid contents in the esophagus. General anesthesia is routinely considered to lower the risk of aspiration; however, it may not be necessary and time efficient approach for pre-POEM evaluation. We aim to characterize our institution’s experience with monitored anesthesia care (MAC) compared to general anesthesia (GA) for this relatively higher anesthesia risk patient population

Methods: This was a single-center, retrospective cohort study at a tertiary care center. All patients who underwent esophageal POEM between 1/2019 and 6/2021 were included. Data were collected for indication of the procedure, type of anesthesia, and pre-POEM EGD, endoscopic ultrasound, EndoFLIP, integrated relaxation pressure and pre-POEM Eckhardt score. Results were analyzed using IBM SPSS™, version 28

Results: 96 patients underwent esophageal POEM during the study period. 11 patients were excluded due to insufficient documentation of anesthesia plan. 68/85 (80%) patients underwent MAC in supine position with head of bed at >45 degree angle; 17/85 (20%) patients underwent general anesthesia. 42.6% and 14.7% patients in MAC group had liquid diet and solid diet respectively within 12 hours prior to endoscopic procedure vs. 29.4% and 11.7% of patients in GA group (p=0.326). Mean Eckhardt score was 8.3; there was no associated between Eckhardt score and anesthesia administered (B=0.89, p=.411). Mean IRP was 25.6 mmHg. 24 (25%) patients had pre-POEM EGD, EUS and EndoFLIP. No major adverse events were documented in the cohort; one patient in MAC group had a COPD exacerbation after pre-POEM work up.

Discussion: Majority of achalasia patients can safely undergo pre-POEM work up using MAC. Retained liquid or bubbles are often present for achalasia patients with instructions to modify their diet pre-procedure. Liquids are cleared intraprocedure with a plan to intubate if solid debris is present. Careful patient selection, adequate patient positioning and close coordination between endoscopist and anesthesiologist can lower the risk of anesthesia related complications to a minimal level while maintaining a time efficient anesthesia approach.



Disclosures:


MUHAMMAD H. BASHIR, MD¹, Umma K. Fatema, ², Vincent Del Duca, ³, Divya Chalikonda, MD⁴, Mario Gonzalez, MD¹, Alex Schlachterman, MD¹. P0633 - Pre-POEM Endoscopic Work Up; Comparison of General Anesthesia and Monitored Anesthesia Care on Patient Outcomes, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.