LAUSR

BACKGROUND AND AIMS Peroral endoscopic myotomy has emerged as a promising treatment option for achalasia and other foregut dysmotility disorders. Much of the current postprocedural care, however, such as mandatory admission and routine esophagrams, has been adapted from current surgical practices and may not in fact be necessary. Here we describe our algorithm and outcomes for same-day discharge. METHODS Outcomes of 103 consecutive patients that underwent POEM for achalasia and other foregut dysmotility disorders from January 2015 to December 2018 were analyzed. Patients were discharged on the same day without esophagrams following a predetermined algorithm based on procedural adverse events and postprocedural pain. Patients were closely monitored after discharge for adverse events at 24 and 48 hours and then routinely in the office setting. RESULTS One hundred one of 103 POEMs were able to be completed successfully. A total of 62.4% were able to be discharged safely on the same day, whereas 29.7% were admitted for mild pain, whereas 7.9% were admitted for observation for other reasons. Overall, there were no serious adverse events at any time point. Univariate analysis identified a duration of disease greater than 3 years, longer length of procedure (50.9 vs 68.5 min, p<0.0001), and longer length of myotomy (7.2 vs 8.5 cm, p<0.0068) as significant factors associated with postprocedural pain requiring admission. CONCLUSIONS Although same-day discharge and foregoing routine esophagram have been suggested by many, this routine has not been systematically implemented. This series suggests that an algorithm for same-day discharge based on postprocedure chest pain, and procedural complexity is both safe and feasible.