# A Comparative Study Investigating the Necessity of Prophylactic ‘Systemic Antibiotic and Gentamicin Tunnel Lavage' in Peroral Endoscopic Myotomy (Poem) and Similar Tunneling Procedures (Z-D-G Poem)

## Authors

- Tarik Akar ([ORCID](https://orcid.org/0000-0001-8209-1513)) — Department of Gastroenterology, Istanbul Hisar Intercontinental Hospital, Istanbul, Turkey

## Article information

- **Journal:** The Ulutas Medical Journal (Ulutas Med J), ISSN 2149-388X
- **Issue:** Volume 7, Issue 3 (2021), pages 193–202
- **Article type:** Original Article
- **Published online:** 2021-09-26
- **DOI:** [10.5455/umj.20210617094444](https://doi.org/10.5455/umj.20210617094444)
- **Licence:** [CC BY-NC 4.0](https://creativecommons.org/licenses/by-nc/4.0/)
- **Article page:** https://www.ulutasmedicaljournal.com/?mno=88876
- **PDF:** https://www.ulutasmedicaljournal.com/pdf/88876.pdf

## Abstract

Introduction: Peroral endoscopic myotomy (POEM) and similar procedures (Z-D-G POEM) are one of the most remarkable topics recently in the gastroenterology community. In this paper, we aimed to investigate the necessity of prophylactic 'systemic antibiotic and gentamicin tunnel lavage' in these procedures. Materials and Methods: From August 2018 to May 2021, we performed Achalasia POEM (35), Zenker's POEM (3), Diverticulum POEM (1), and Gastric POEM (2). Of these, 21 patients received prophylactic ‘systemic antibiotic and gentamicin tunnel lavage' and the others (20 patients) nothing. The primary topics of the research were an adverse event, fever, changes in inflammatory markers(c-reactive protein (CRP), white blood cell(WBC), the length of hospital stay, and re-admission rate to the hospital. Results: The mean age was 46.96±15.44 (21-78) and male/female ratio was 26 (67.9%) /15 (32.1%). Comparing groups with and without antibiotics, there was no difference between the two groups as to several adverse events, hospital stay, fever, levels of CRP, and WBC count(all p-values>0.05). The median CRP values on day 1 and day 3 were somewhat high in the antibiotic negative group but were not statistically different (p:0.667 and p:0.839). The median values of WBC of days 1, 3, and 5 were similar in both groups (all p-values>0.05). The mean follow-up days were 396±182.7 and 197.7±18.62 in the antibiotic (+) and antibiotic (-) groups, respectively (p

## Keywords

Peroral endoscopic myotomy; antibiotic; gentamicin; achalasia; dysphagia; infection

## How to cite

Akar T. A Comparative Study Investigating the Necessity of Prophylactic ‘Systemic Antibiotic and Gentamicin Tunnel Lavage' in Peroral Endoscopic Myotomy (Poem) and Similar Tunneling Procedures (Z-D-G Poem). Ulutas Med J. 2021;7(3):193-202. doi:10.5455/umj.20210617094444

## References

1. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(4):265-71 https://doi.org/10.1055/s-0029-1244080
2. Inoue H, Tianle KM, Ikeda H, Hosoya T, Onimaru M, Yoshida A. Peroral endoscopic myotomy for esophageal achalasia: technique, indication, and outcomes. Thorac Surg Clin. 2011;21 (4):519-25 https://doi.org/10.1016/j.thorsurg.2011.08.005
3. Yan J, Tan Y, Zhou B, Zhang S, Wang X, Liu D. Gastric per-oral endoscopic myotomy (G-POEM) is a promising treatment for refractory gastroparesis: a systematic review and meta-analysis. Rev Esp Enferm Dig. 2020;112(3):219-28 https://doi.org/10.17235/reed.2020.6559/2019
4. Sato H, Takeuchi M, Hashimoto S, Mizuno KI, Furukawa K, Sato A, et al. Esophageal diverticulum: New perspectives in the era of minimally invasive endoscopic treatment. World J Gastroenterol. 2019;25(12):1457-64 202 77 Systemic Antibiotic and Gentamicin Tunnel Lavage Tarık Akar https://doi.org/10.3748/wjg.v25.i12.1457
5. Bechara R, Onimaru M, Ikeda H, Inoue H. Per-oral endoscopic myotomy, 1000 cases later: pearls, pitfalls, and practical considerations. Gastrointest Endosc. 2016;84(2):330-8 https://doi.org/10.1016/j.gie.2016.03.1469
6. Chai NL, Li HK, Linghu EQ, Li ZS, Zhang ST, Bao Y, et al. Consensus on the digestive endoscopic tunnel technique. World J Gastroenterol. 2019;25(7):744-76
7. Ramchandani M, Nageshwar Reddy D, Darisetty S, Kotla R, Chavan R, Kalpala R, et al. Peroral endoscopic myotomy for achalasia cardia: Treatment analysis and follow up of over 200 consecutive patients at a single center. Dig Endosc. 2016;28 (1):19-26 https://doi.org/10.1111/den.12495
8. Nabi Z, Ramchandani M, Chavan R, Darisetty S, Kalapala R, Shava U, et al. Outcome of peroral endoscopic myotomy in children with achalasia. Surg Endosc. 2019;33(11):3656-64 https://doi.org/10.1007/s00464-018-06654-1
9. Inoue H, Shiwaku H, Iwakiri K, Onimaru M, Kobayashi Y, Minami H, et al. Clinical practice guidelines for peroral endoscopic myotomy. Dig Endosc. 2018;30(5):563-79 https://doi.org/10.1111/den.13239
10. Weusten BLAM, Barret M, Bredenoord AJ, Familiari P, Gonzalez JM, van Hooft JE, et al. Endoscopic management of gastrointestinal motility disorders - part 1: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. https://doi.org/10.1055/a-1160-5549
11. Podboy AJ, Hwang JH, Rivas H, Azagury D, Hawn M, Lau J, et al. Long-term outcomes of per-oral endoscopic myotomy compared to laparoscopic Heller myotomy for achalasia: a single-center experience. Surg Endosc. 2020 https://doi.org/10.1007/s00464-020-07450-6
12. Crespin OM, Liu LWC, Parmar A, Jackson TD, Hamid J, Shlomovitz E, et al. Safety and efficacy of POEM for treatment of achalasia: a systematic review of the literature. Surg Endosc. 2017;31(5):2187-201 https://doi.org/10.1007/s00464-016-5217-y
13. de Pascale S, Repici A, Puccetti F, Carlani E, Rosati R, Fumagalli U. Peroral endoscopic myotomy versus surgical myotomy for primary achalasia: single -center, retrospective analysis of 74 patients. Dis Esophagus. 2017;30(8):1-7 https://doi.org/10.1093/dote/dox028
14. Haito-Chavez Y, Inoue H, Beard KW, Draganov PV, Ujiki M, Rahden BHA, et al. Comprehensive Analysis of Adverse Events Associated With Per Oral Endoscopic Myotomy in 1826 Patients: An International Multicenter Study. Am J Gastroenterol. 2017;112(8):1267-76 https://doi.org/10.1038/ajg.2017.139
15. Chang WK, Srinivasa S, MacCormick AD, Hill AG. Gentamicin-collagen implants to reduce surgical site infection: systematic review and meta-analysis of randomized trials. Ann Surg. 2013;258(1):59-65 https://doi.org/10.1097/sla.0b013e3182895b8c
16. Tao J, Patel V, Mekaroonkamol P, Luo H, Li B, Guan Q, et al. Technical Aspects of Peroral Endoscopic Pyloromyotomy. Gastrointest Endosc Clin N Am. 2019;29(1):117-26 https://doi.org/10.1016/j.giec.2018.08.012
17. Bayer J, Vackova Z, Svecova H, Stirand P, Spicak J, Martinek J. Gentamicin submucosal lavage during peroral endoscopic myotomy (POEM): a retrospective analysis. Surg Endosc. 2018; 32(1):300-6 https://doi.org/10.1007/s00464-017-5677-8
18. Becattini S, Taur Y, Pamer EG. Antibiotic-Induced Changes in the Intestinal Microbiota and Disease. Trends Mol Med. 2016; 22(6):458-78 https://doi.org/10.1016/j.molmed.2016.04.003
19. Ichkhanian Y, Vosoughi K, Aghaie Meybodi M, Jacques J, Sethi A, Patel AA, et al. Comprehensive Analysis of Adverse Events Associated with Gastric Peroral Endoscopic Myotomy: An International Multicenter Study. Surg Endosc. 2020 https://doi.org/10.1007/s00464-020-07570-z
20. Schimmer C, Gross J, Ramm E, Morfeld BC, Hoffmann G, Panholzer B, et al. Prevention of surgical site sternal infections in cardiac surgery: a two-centre prospective randomized controlled study. Eur J Cardiothorac Surg. 2017;51(1):67-72 https://doi.org/10.1093/ejcts/ezw225
21. Nabi Z, Reddy DN, Ramchandani M. Adverse events during and after per-oral endoscopic myotomy: prevention, diagnosis, and management. Gastrointest Endosc. 2018;87(1): 4-17 https://doi.org/10.1016/j.gie.2017.09.029
22. Zhang YQ, Yao LQ, Xu MD, Li QL, Chen WF, Hu JW, et al. Early diagnosis and management of esophageal leakage after peroral endoscopic myotomy for achalasia. Turk J Gastro enterol. 2016;27(2):97-102 https://doi.org/10.5152/tjg.2016.15412
23. Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, et al. Per-Oral Endoscopic Myotomy: A Series of 500 Patients. J Am Coll Surg. 2015;221(2):256-64 https://doi.org/10.1016/j.jamcollsurg.2015.03.057
24. Patel K, Abbassi-Ghadi N, Markar S, Kumar S, Jethwa P, Zaninotto G. Peroral endoscopic myotomy for the treatment of esophageal achalasia: systematic review and pooled analysis. Dis Esophagus. 2016;29(7):807-19 https://doi.org/10.1111/dote.12387
25. Werner YB, Hakanson B, Martinek J, Repici A, von Rahden BHA, Bredenoord AJ, et al. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. N Engl J Med. 2019;381 (23):2219-29 https://doi.org/10.1056/nejmoa1905380
26. Zhai Y, Enquiang L, Huikai L, Xiaolin S, Lihua P. Is preoperative antibiotics necessary for infection preventing before peroral endoscopic myotomy. American Journal Gastroentrology. 2013;108(11):s587 https://doi.org/10.14309/00000434-201310001-01939
27. Zhang XC, Li QL, Xu MD, Chen SY, Zhong YS, Zhang YQ, et al. Major perioperative adverse events of peroral endoscopic myotomy: a systematic 5-year analysis. Endoscopy. 2016;48 (11):967-78 https://doi.org/10.1055/s-0042-110397