North American Expert Consensus on the Post-procedural Care of Patients After Per-oral Endoscopic Myotomy Using a Delphi Process

Dennis Yang; Abdul Mohammed; Rena Yadlapati; Andrew Y. Wang; Thurarshen Jeyalingam; Peter V. Draganov; Ernesto Robalino Gonzaga; Muhammad K. Hasan; Alexander Schlachterman; Ming Ming Xu; Ahmed Saeed; Aziz Aadam; Reem Z. Sharaiha; Ryan Law; Louis M. Wong Kee Song; Monica Saumoy; John E. Pandolfino; Makoto Nishimura; Michel Kahaleh; Joo Ha Hwang; Robert Bechara; Vani JA Konda; John M. DeWitt; Prashant Kedia; Nikhil A. Kumta; Irteza Inayat; Stavros N. Stavropoulos; Vivek Kumbhari; Uzma D. Siddiqui; Salmaan Jawaid; Sherif Andrawes; Mouen Khashab; Joseph R. Triggs; Neil Sharma; Mohamed Othman; Amrita Sethi; Alexandra J. Baumann; Cyrus Priraka; Christy M. Dunst; Mihir S. Wagh; Mohammad Al-Haddad; C. Prakash Gyawali; Sergey Kantsevoy; B. Joseph Elmunzer

doi:10.1016/j.cgh.2024.08.024

North American Expert Consensus on the Post-procedural Care of Patients After Per-oral Endoscopic Myotomy Using a Delphi Process

Dennis Yang^*, Abdul Mohammed, Rena Yadlapati, Andrew Y. Wang, Thurarshen Jeyalingam, Peter V. Draganov, Ernesto Robalino Gonzaga, Muhammad K. Hasan, Alexander Schlachterman, Ming Ming Xu, Ahmed Saeed, Aziz Aadam, Reem Z. Sharaiha, Ryan Law, Louis M. Wong Kee Song, Monica Saumoy, John E. Pandolfino, Makoto Nishimura, Michel Kahaleh, Joo Ha HwangRobert Bechara, Vani JA Konda, John M. DeWitt, Prashant Kedia, Nikhil A. Kumta, Irteza Inayat, Stavros N. Stavropoulos, Vivek Kumbhari, Uzma D. Siddiqui, Salmaan Jawaid, Sherif Andrawes, Mouen Khashab, Joseph R. Triggs, Neil Sharma, Mohamed Othman, Amrita Sethi, Alexandra J. Baumann, Cyrus Priraka, Christy M. Dunst, Mihir S. Wagh, Mohammad Al-Haddad, C. Prakash Gyawali, Sergey Kantsevoy, B. Joseph Elmunzer

^*Corresponding author for this work

Medicine, Gastroenterology Division

Research output: Contribution to journal › Article › peer-review

Abstract

Background & Aims: There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a consensus on several important questions on the after care of post-POEM patients through a modified Delphi process. Methods: A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management. A total of 34 experts participated in the 2 rounds of the Delphi process, with quantitative and qualitative data analyzed for each round to achieve consensus. Results: A total of 23 statements achieved a high degree of consensus. Overall, the expert panel agreed on the following: (1) same-day discharge after POEM can be considered in select patients; (2) a single dose of prophylactic antibiotics may be as effective as a short course; (3) a modified diet can be advanced as tolerated; and (4) all patients should be followed in clinic and undergo objective testing for surveillance and management of reflux. Consensus could not be achieved on the indication of post-POEM esophagram to evaluate for leak. Conclusions: The results of this Delphi process established expert agreement on several important issues and provides practical guidance on key aspects in the care of patients following POEM.

Original language	English (US)
Journal	Clinical Gastroenterology and Hepatology
DOIs	https://doi.org/10.1016/j.cgh.2024.08.024
State	Accepted/In press - 2024

Funding

Dennis Yang, MD (Conceptualization: Lead; Data curation: Lead; Formal analysis: Lead; Methodology: Lead; Project administration: Lead; Writing \u2013 original draft: Lead), Abdul Mohammed (Data curation: Supporting; Formal analysis: Supporting; Project administration: Supporting), Rena Yadlapati (Conceptualization: Supporting; Methodology: Supporting), Andrew Y. Wang (Conceptualization: Supporting; Methodology: Supporting), Thurarshen Jeyalingam (Conceptualization: Supporting; Methodology: Supporting), Peter V. Draganov (Conceptualization: Supporting; Methodology: Supporting), Ernesto Robalino Gonzaga (Resources: Supporting; Writing \u2013 review & editing: Supporting), Muhammad K. Hasan (Resources: Supporting; Writing \u2013 review & editing: Supporting), Alexander Schlachterman (Resources: Supporting; Writing \u2013 review & editing: Supporting), Ming-Ming Xu (Resources: Supporting; Writing \u2013 review & editing: Supporting), Ahmed Saeed (Resources: Supporting; Writing \u2013 review & editing: Supporting), Aziz Aadam (Resources: Supporting; Writing \u2013 review & editing: Supporting), Reem Z. Sharaiha (Resources: Supporting; Writing \u2013 review & editing: Supporting), Ryan Law (Resources: Supporting; Writing \u2013 review & editing: Supporting), Louis M. Wong Kee Song (Resources: Supporting; Writing \u2013 review & editing: Supporting), Monica Saumoy (Resources: Supporting; Writing \u2013 review & editing: Supporting), John E. Pandolfino (Resources: Supporting; Writing \u2013 review & editing: Supporting), Makoto Nishimura (Resources: Supporting; Writing \u2013 review & editing: Supporting), Michel Kahaleh (Resources: Supporting; Writing \u2013 review & editing: Supporting), Joo Ha Hwang (Resources: Supporting; Writing \u2013 review & editing: Supporting), Robert Bechara (Resources: Supporting; Writing \u2013 review & editing: Supporting), Vani JA Konda (Resources: Supporting; Writing \u2013 review & editing: Supporting), John M. DeWitt (Resources: Supporting; Writing \u2013 review & editing: Supporting), Prashant Kedia (Resources: Supporting; Writing \u2013 review & editing: Supporting), Nikhil A. Kumta (Resources: Supporting; Writing \u2013 review & editing: Supporting), Irteza Inayat (Resources: Supporting; Writing \u2013 review & editing: Supporting), Stavros N. Stavropoulos (Resources: Supporting; Writing \u2013 review & editing: Supporting), Vivek Kumbhari (Resources: Supporting; Writing \u2013 review & editing: Supporting), Uzma D. Siddiqui (Resources: Supporting; Writing \u2013 review & editing: Supporting), Salmaan Jawaid (Resources: Supporting; Writing \u2013 review & editing: Supporting), Sherif Andrawes (Resources: Supporting; Writing \u2013 review & editing: Supporting), Mouen Khashab (Resources: Supporting; Writing \u2013 review & editing: Supporting), Joseph R. Triggs (Resources: Supporting; Writing \u2013 review & editing: Supporting), Neil Sharma (Resources: Supporting; Writing \u2013 review & editing: Supporting), Mohamed Othman (Resources: Supporting; Writing \u2013 review & editing: Supporting), Amritha Sethi (Resources: Supporting; Writing \u2013 review & editing: Supporting), Alexandra J. Baumann (Resources: Supporting; Writing \u2013 review & editing: Supporting), Cyrus Priraka (Resources: Supporting; Writing \u2013 review & editing: Supporting), Christy M. Dunst (Resources: Supporting; Writing \u2013 review & editing: Supporting), Mihir S. Wagh (Resources: Supporting; Writing \u2013 review & editing: Supporting), Mohammad Al-Haddad (Resources: Supporting; Writing \u2013 review & editing: Supporting), Prakash Gyawali (Resources: Supporting; Writing \u2013 review & editing: Supporting), Sergey Kantsevoy (Resources: Supporting; Writing \u2013 review & editing: Supporting), B. Joseph Elmunzer (Conceptualization: Supporting; Methodology: Supporting)

Keywords

Delphi Process
POEM
Per-oral Endoscopic Myotomy

ASJC Scopus subject areas

Hepatology
Gastroenterology

Access to Document

10.1016/j.cgh.2024.08.024

Cite this

Yang, D., Mohammed, A., Yadlapati, R., Wang, A. Y., Jeyalingam, T., Draganov, P. V., Gonzaga, E. R., Hasan, M. K., Schlachterman, A., Xu, M. M., Saeed, A., Aadam, A., Sharaiha, R. Z., Law, R., Wong Kee Song, L. M., Saumoy, M., Pandolfino, J. E., Nishimura, M., Kahaleh, M., ... Elmunzer, B. J. (Accepted/In press). North American Expert Consensus on the Post-procedural Care of Patients After Per-oral Endoscopic Myotomy Using a Delphi Process. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2024.08.024

@article{6f2ca32a84eb4f838ad3254b7a1af60d,

title = "North American Expert Consensus on the Post-procedural Care of Patients After Per-oral Endoscopic Myotomy Using a Delphi Process",

abstract = "Background & Aims: There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a consensus on several important questions on the after care of post-POEM patients through a modified Delphi process. Methods: A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management. A total of 34 experts participated in the 2 rounds of the Delphi process, with quantitative and qualitative data analyzed for each round to achieve consensus. Results: A total of 23 statements achieved a high degree of consensus. Overall, the expert panel agreed on the following: (1) same-day discharge after POEM can be considered in select patients; (2) a single dose of prophylactic antibiotics may be as effective as a short course; (3) a modified diet can be advanced as tolerated; and (4) all patients should be followed in clinic and undergo objective testing for surveillance and management of reflux. Consensus could not be achieved on the indication of post-POEM esophagram to evaluate for leak. Conclusions: The results of this Delphi process established expert agreement on several important issues and provides practical guidance on key aspects in the care of patients following POEM.",

keywords = "Delphi Process, POEM, Per-oral Endoscopic Myotomy",

author = "Dennis Yang and Abdul Mohammed and Rena Yadlapati and Wang, {Andrew Y.} and Thurarshen Jeyalingam and Draganov, {Peter V.} and Gonzaga, {Ernesto Robalino} and Hasan, {Muhammad K.} and Alexander Schlachterman and Xu, {Ming Ming} and Ahmed Saeed and Aziz Aadam and Sharaiha, {Reem Z.} and Ryan Law and {Wong Kee Song}, {Louis M.} and Monica Saumoy and Pandolfino, {John E.} and Makoto Nishimura and Michel Kahaleh and Hwang, {Joo Ha} and Robert Bechara and Konda, {Vani JA} and DeWitt, {John M.} and Prashant Kedia and Kumta, {Nikhil A.} and Irteza Inayat and Stavropoulos, {Stavros N.} and Vivek Kumbhari and Siddiqui, {Uzma D.} and Salmaan Jawaid and Sherif Andrawes and Mouen Khashab and Triggs, {Joseph R.} and Neil Sharma and Mohamed Othman and Amrita Sethi and Baumann, {Alexandra J.} and Cyrus Priraka and Dunst, {Christy M.} and Wagh, {Mihir S.} and Mohammad Al-Haddad and Gyawali, {C. Prakash} and Sergey Kantsevoy and Elmunzer, {B. Joseph}",

note = "Publisher Copyright: {\textcopyright} 2024 AGA Institute",

year = "2024",

doi = "10.1016/j.cgh.2024.08.024",

language = "English (US)",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B. Saunders",

}

Yang, D, Mohammed, A, Yadlapati, R, Wang, AY, Jeyalingam, T, Draganov, PV, Gonzaga, ER, Hasan, MK, Schlachterman, A, Xu, MM, Saeed, A, Aadam, A, Sharaiha, RZ, Law, R, Wong Kee Song, LM, Saumoy, M, Pandolfino, JE, Nishimura, M, Kahaleh, M, Hwang, JH, Bechara, R, Konda, VJA, DeWitt, JM, Kedia, P, Kumta, NA, Inayat, I, Stavropoulos, SN, Kumbhari, V, Siddiqui, UD, Jawaid, S, Andrawes, S, Khashab, M, Triggs, JR, Sharma, N, Othman, M, Sethi, A, Baumann, AJ, Priraka, C, Dunst, CM, Wagh, MS, Al-Haddad, M, Gyawali, CP, Kantsevoy, S & Elmunzer, BJ 2024, 'North American Expert Consensus on the Post-procedural Care of Patients After Per-oral Endoscopic Myotomy Using a Delphi Process', Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2024.08.024

TY - JOUR

T1 - North American Expert Consensus on the Post-procedural Care of Patients After Per-oral Endoscopic Myotomy Using a Delphi Process

AU - Yang, Dennis

AU - Mohammed, Abdul

AU - Yadlapati, Rena

AU - Wang, Andrew Y.

AU - Jeyalingam, Thurarshen

AU - Draganov, Peter V.

AU - Gonzaga, Ernesto Robalino

AU - Hasan, Muhammad K.

AU - Schlachterman, Alexander

AU - Xu, Ming Ming

AU - Saeed, Ahmed

AU - Aadam, Aziz

AU - Sharaiha, Reem Z.

AU - Law, Ryan

AU - Wong Kee Song, Louis M.

AU - Saumoy, Monica

AU - Pandolfino, John E.

AU - Nishimura, Makoto

AU - Kahaleh, Michel

AU - Hwang, Joo Ha

AU - Bechara, Robert

AU - Konda, Vani JA

AU - DeWitt, John M.

AU - Kedia, Prashant

AU - Kumta, Nikhil A.

AU - Inayat, Irteza

AU - Stavropoulos, Stavros N.

AU - Kumbhari, Vivek

AU - Siddiqui, Uzma D.

AU - Jawaid, Salmaan

AU - Andrawes, Sherif

AU - Khashab, Mouen

AU - Triggs, Joseph R.

AU - Sharma, Neil

AU - Othman, Mohamed

AU - Sethi, Amrita

AU - Baumann, Alexandra J.

AU - Priraka, Cyrus

AU - Dunst, Christy M.

AU - Wagh, Mihir S.

AU - Al-Haddad, Mohammad

AU - Gyawali, C. Prakash

AU - Kantsevoy, Sergey

AU - Elmunzer, B. Joseph

PY - 2024

Y1 - 2024

N2 - Background & Aims: There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a consensus on several important questions on the after care of post-POEM patients through a modified Delphi process. Methods: A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management. A total of 34 experts participated in the 2 rounds of the Delphi process, with quantitative and qualitative data analyzed for each round to achieve consensus. Results: A total of 23 statements achieved a high degree of consensus. Overall, the expert panel agreed on the following: (1) same-day discharge after POEM can be considered in select patients; (2) a single dose of prophylactic antibiotics may be as effective as a short course; (3) a modified diet can be advanced as tolerated; and (4) all patients should be followed in clinic and undergo objective testing for surveillance and management of reflux. Consensus could not be achieved on the indication of post-POEM esophagram to evaluate for leak. Conclusions: The results of this Delphi process established expert agreement on several important issues and provides practical guidance on key aspects in the care of patients following POEM.

AB - Background & Aims: There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a consensus on several important questions on the after care of post-POEM patients through a modified Delphi process. Methods: A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management. A total of 34 experts participated in the 2 rounds of the Delphi process, with quantitative and qualitative data analyzed for each round to achieve consensus. Results: A total of 23 statements achieved a high degree of consensus. Overall, the expert panel agreed on the following: (1) same-day discharge after POEM can be considered in select patients; (2) a single dose of prophylactic antibiotics may be as effective as a short course; (3) a modified diet can be advanced as tolerated; and (4) all patients should be followed in clinic and undergo objective testing for surveillance and management of reflux. Consensus could not be achieved on the indication of post-POEM esophagram to evaluate for leak. Conclusions: The results of this Delphi process established expert agreement on several important issues and provides practical guidance on key aspects in the care of patients following POEM.

KW - Delphi Process

KW - POEM

KW - Per-oral Endoscopic Myotomy

UR - http://www.scopus.com/inward/record.url?scp=85205681465&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85205681465&partnerID=8YFLogxK

U2 - 10.1016/j.cgh.2024.08.024

DO - 10.1016/j.cgh.2024.08.024

M3 - Article

C2 - 39214390

AN - SCOPUS:85205681465

SN - 1542-3565

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

ER -

North American Expert Consensus on the Post-procedural Care of Patients After Per-oral Endoscopic Myotomy Using a Delphi Process

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