Abstract
Background and study aims COVID-19 has significantly impacted endoscopic assessment and management of multiple
conditions. Our group recommenced treatment of highly symptomatic achalasia patients
(Eckardt score ≥ 6) adopting a same-day discharge (SDD) algorithm and present early
outcomes of its utilization.
Patients and methods We enrolled all outpatients undergoing POEM at a single tertiary referral center.
Patients qualified for SDD if all of the following a priori criteria were met: 1)
ASA grade I-III; 2) No intraprocedural adverse events (AEs); 3) Secure mucosal closure;
4) Post-procedure pain/nausea responsive to oral medications; and 5) Patients tolerating
clear fluids.
Results In 17 potential SDD candidates (female 82.4 %, median age 51 years [IQR 48–64]) undergoing
POEM, SDD was achieved in 14 (82.4 %). The remaining were admitted due to post-procedure
pain/nausea (n = 2) and intraprocedural concerns (capnoperitoneum requiring needle
decompression, n = 1). There were no post-procedure AEs or unexpected readmissions.
Conclusions This study demonstrates the safety and feasibility of a SDD algorithm for POEM patients
and challenges the necessity of routine post-POEM hospital admission. Critically important
during the COVID-19 pandemic, this may in fact constitute a changing standard for
POEM post-procedure care.
