ESOPHAGEAL CLEANSING BEFORE POEM – A SIMPLE AND EFFECTIVE TECHNIQUE

Aims:

To devise a simple yet effective method for pre procedural oesophageal preparation for POEM.

Methods:

We have devised a scoring system depending on the esophageal mucosa, presence of fluid/froth and severity of candidial infection on the initial endoscopy.

• Grade I – clean esophagus

• Grade II – presence of fluid/froth + crumpled but normal mucosa

• Grade III- fluid/froth + intermittent esophageal candidiasis

• Grade IV- fluid/froth + severe esophageal candidiasis

• Grade V- extensive food residue with candidial infection

This is a comparative analysis of 100 patients with achalasia cardia confirmed on endoscopy and HRM. The first 50 (Group – A) patients were prepared with conventional preparation:

1. Clear liquids for 48 hours

2. NBM for 24 hours prior to POEM

3. Thorough wash with saline day before POEM

The subsequent 50 patients (Group – B) were prepared with simple and novel method:

1. patients are kept on warm water and a “carbonated drink” only

2. NBM for 6 hours prior to POEM

3. No wash was given.

Results:

• Grade I 14 12

• Grade II 13 21

• Grade III 13. 06

• Grade IV 06 07

• Grade V. 04. 04

No difference was found in group I to III as far as luminal clearance was concerned.

Group-B was superior in terms of shorter stay, less cost (10000 INR less) and more compliance. All patients of grade-V and two patients of grade-IV in group-A required additional wash prior to POEM due to food residue where group-B patients had clear lumen even in grade-IV and V. Group-B patients had less exposure to anesthesia as and less risk as they had much clearer esophageal lumen.

Conclusions:

Simple warm water before POEM, cleans the oesophagus far better than any other agent.

Decreases time of preparation and improves patient compliance.

Very cheap and cost effective.

Reduces anaesthesia risk and time.