Peroral Endoskopik Miyotomi Girişiminde Anestezi Deneyimimiz
Özet
Akalazya özofagusun motor fonksiyon bozukluğudur. Alt özofagus sfinkterinin yeterli gevşeyememesi ve peristaltizim bozukluğu ile karakterize, nadir görülen bir hastalıktır. Akalazya tedavisinde laparoskopik ya da robotik olarak yapılan cerrahi miyotomi (Heller miyotomi), balon dilatasyon yöntemi ile gevşetme, alt özofagial sfinktere botilinum toksini uygulamaları ve çeşitli ilaçlar kullanılmaktadır (1). Peroral endoskopik miyotomi (POEM) ilk kez 2008 yılında Innoue ve arkadaşları tarafından akalazyanın tedavisinde laparoskopik Heller miyotomiye alternatif olacak bir yöntem olarak tanımlanmıştır (2). Akalazya hastalarında POEM'in etkinliğini ve güvenliğini değerlendiren çok sayıda çalışma yayınlanmıştır ve hastaların % 80-90'ından fazlasında mükemmel klinik yanıt gösterilmiştir. POEM uygulamasında ciddi yan etkiler nadirdir ve gelişirse çoğunlukla işlem sırasında yönetilebilmektedir. Bu yazıda POEM sırasında pnömoperitonyum ve subkutan amfizem gelişen 31 yaşındaki erkek olgunun anestezi yönetiminin sunulması amaçlanmıştır.
Achalasia is a motor dysfunction of the esophagus. It is a rare illness that is characterized by inadequate relaxation of the lower esophageal sphincter and impaired peristalsism. Achalasia is treated with surgical myotomy that is performed laparoscopically or robotically, relaxation by balloon dilation, botulinum toxin injections to the lower esophageal sphincter, and various drugs. Peroral endoscopic myotomy (POEM) was defined for the first time in 2008 by Inoue et al. as an alternative to laparoscopic Heller myotomy in the treatment of achalasia. Several studies examining the effectiveness and safety of POEM in achalasia patients have been published, and excellent clinical response has been demonstrated in more than 80-90% of patients. Severe complications are rare in POEM procedures, and those that develop can usually be managed during the procedure. This report presents the anesthesia method performed for a 31-year-old male patient who developed pneumoperitoneum and subcutaneous emphysema during POEM.
Referanslar
Pesce M, Pagliaro M, Sarnelli G, et al. Modern achalasia: Diagnosis, classification, and treatment. Journal of Neurogastroenterology and Motility. 2023;29(4): 419-427. doi: 10.5056/jnm23125.
Inou H, Minami Y, Kobayashi Y,et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(04): 265-271. doi: 10.1055/s-0029-1244080.
Ujiki MB, VanDruff VN. Peroral Endoscopic Myotomy for Achalasia. World Journal of Surgery. 2022;46(7): 1542-1546. doi: 10.1007/s00268-022-06477-1.
Tefas C, Ababneh R, Tanţău M. Peroral Endoscopic Myotomy Versus Heller Myotomy for Achalasia: Pros and Cons. Chirurgia (Bucur). 2018;113(2): 185-191.mdoi: 10.21614/chirurgia.113.2.185.
Löser B, Recio Ariza O, Saugel B,et al. Anesthesia for Patients Undergoing Peroral Endoscopic Myotomy Procedures: A Review of the Literature. Anesthsia Analgesia. 2020;130(5): 1331-1340. doi: 10.1213/ANE.0000000000004420.
Murata H, Ichinomiya T, Hara T. Anesthesia for peroral endoscopic myotomy in Japan. Current Opinion in Anesthesiology. 2019;32(4): 511-516. doi: 10.1097/ACO.0000000000000742.
Misra L, Fukami N, Nikolic K, et al. Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician. Medical Devices: Evidence and Research. 2017; 23(10):53-59. doi: 10.2147/MDER.S115632.
Kim GE, Kim DK, Choi JW, et al. The safety of endoscopic esophageal procedures under general anesthesia. Korean Journal of Anesthesiology. 2017;70(5): 555-560. doi: 10.4097/kjae.2017.70.5.555.
Inoue H, Shiwaku H, Iwakiri K, et al. Clinical practice guidelines for peroral endoscopic myotomy. Digestive Endoscopy. 2018;30(5): 563-579. doi: 10.1111/den.13239.
Bang YS, Park C. Anesthetic Consideration for Peroral Endoscopic Myotomy. Clinical Endoscopy. 2019;52(6): 549-555. doi: 10.5946/ce.2019.033.
Yurtlu DA, Aslan F. Challenges in anesthesia management for peroral endoscopic mMyotomy: A retrospective analysis. Surgical Laparoscopy Endoscopy Percutaneous Techniques. 2021;31(6):729-733. doi: 10.1097/SLE.0000000000000978.
Nabi Z, Reddy DN, Ramchandani M. Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management. Gastrointestal Endoscopy. 2018;87(1):4-17. doi: 10.1016/j.gie.2017.09.029.
Gonzalez JM, Benezech A, Barthet M. Complications of submucosal endoscopy. Best Practice & Research Clinical Gastroenterology. 2016;30(5): 783-791. doi: 10.1016/j.bpg.2016.10.015.
Referanslar
Pesce M, Pagliaro M, Sarnelli G, et al. Modern achalasia: Diagnosis, classification, and treatment. Journal of Neurogastroenterology and Motility. 2023;29(4): 419-427. doi: 10.5056/jnm23125.
Inou H, Minami Y, Kobayashi Y,et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(04): 265-271. doi: 10.1055/s-0029-1244080.
Ujiki MB, VanDruff VN. Peroral Endoscopic Myotomy for Achalasia. World Journal of Surgery. 2022;46(7): 1542-1546. doi: 10.1007/s00268-022-06477-1.
Tefas C, Ababneh R, Tanţău M. Peroral Endoscopic Myotomy Versus Heller Myotomy for Achalasia: Pros and Cons. Chirurgia (Bucur). 2018;113(2): 185-191.mdoi: 10.21614/chirurgia.113.2.185.
Löser B, Recio Ariza O, Saugel B,et al. Anesthesia for Patients Undergoing Peroral Endoscopic Myotomy Procedures: A Review of the Literature. Anesthsia Analgesia. 2020;130(5): 1331-1340. doi: 10.1213/ANE.0000000000004420.
Murata H, Ichinomiya T, Hara T. Anesthesia for peroral endoscopic myotomy in Japan. Current Opinion in Anesthesiology. 2019;32(4): 511-516. doi: 10.1097/ACO.0000000000000742.
Misra L, Fukami N, Nikolic K, et al. Peroral endoscopic myotomy: procedural complications and pain management for the perioperative clinician. Medical Devices: Evidence and Research. 2017; 23(10):53-59. doi: 10.2147/MDER.S115632.
Kim GE, Kim DK, Choi JW, et al. The safety of endoscopic esophageal procedures under general anesthesia. Korean Journal of Anesthesiology. 2017;70(5): 555-560. doi: 10.4097/kjae.2017.70.5.555.
Inoue H, Shiwaku H, Iwakiri K, et al. Clinical practice guidelines for peroral endoscopic myotomy. Digestive Endoscopy. 2018;30(5): 563-579. doi: 10.1111/den.13239.
Bang YS, Park C. Anesthetic Consideration for Peroral Endoscopic Myotomy. Clinical Endoscopy. 2019;52(6): 549-555. doi: 10.5946/ce.2019.033.
Yurtlu DA, Aslan F. Challenges in anesthesia management for peroral endoscopic mMyotomy: A retrospective analysis. Surgical Laparoscopy Endoscopy Percutaneous Techniques. 2021;31(6):729-733. doi: 10.1097/SLE.0000000000000978.
Nabi Z, Reddy DN, Ramchandani M. Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management. Gastrointestal Endoscopy. 2018;87(1):4-17. doi: 10.1016/j.gie.2017.09.029.
Gonzalez JM, Benezech A, Barthet M. Complications of submucosal endoscopy. Best Practice & Research Clinical Gastroenterology. 2016;30(5): 783-791. doi: 10.1016/j.bpg.2016.10.015.
