P1022 - Same Day Discharge vs Overnight Admission for Outpatient Esophageal Per-Oral Endoscopic Myotomy

Zane Gouda, MD¹, Grace Schiavone, BA¹, Joy Zhao, MD², Julietta Gervase, BA¹, Joria Le, RN, BSN², Marcel Robles, MD², Anand Kumar, MD, MPH², Alexander Schlachterman, MD^1
1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; ²Thomas Jefferson University Hospital, Philadelphia, PA

Introduction: E-POEM has become an important treatment option for patients with esophageal disorders, but there is limited data about factors that lead to a same day discharge (SDD) or overnight admission (OA) for outpatient E-POEM. We aimed to assess pre-procedural factors and clinical outcomes associated with SDD when compared to OA.

Methods: This is a single center retrospective analysis of all patients undergoing outpatient E-POEM from 1/2019 through 5/2024 at an academic institution. Data was collected on patient demographics, pre-, intra-, and post-procedural characteristics, and procedure charges. Technical success was defined as successful myotomy and closure.

Results: 218 patients underwent outpatient E-POEM (36 SDD, 182 OA). Technical success was 100%. The average age was 54.1 in the SDD cohort and 62.4 in the OA group (p=0.0068). 3/36 patients in the SDD cohort underwent prior heller myotomy compared to 30/182 OA patients (p=0.979). In the SDD group, 3/36 patients had afternoon procedures compared to 48/182 patients in the OA group (p=0.0194). The average length of procedure was 72.5 minutes in the SDD group and 69.0 minutes in the OA group (p=0.534). 11/36 patients in the SDD group required post procedural opioids compared to 109/182 patients in the OA group (p=0.00114). 34/87 patients in the OA group with a same day esophagram did not require opioids. All patients received IV acetaminophen at time of closure. Average time of day for esophagrams performed the day of procedure was 1515 and 1508 in the SDD and OA groups, respectively, and 1035 when performed the day after procedure. There was no difference in closure technique, adverse events, or additional treatments required between SDD and OA groups. The average charge per patient in the SDD group was $6,862 and $7,924 in the OA group (p=0.171).

Discussion: Patients with E-POEM procedures with SDD were more likely to be younger, undergo morning procedures, and use less opiates. Pre-Procedural Eckardt scores, prior interventions, and intraprocedural characteristics did not correlate with timing of discharge. Standardizing a protocol where outpatient E-POEMs are performed before noon with same day post-procedural esophagrams scheduled may facilitate SDD for patients who do not require opiates for pain control, although this may be limited by the closing time of the radiology department at each institution. SDD may also lead to less charges incurred by patients, although this difference was not statistically significant in our sample size.


Disclosures:


Zane Gouda, MD¹, Grace Schiavone, BA¹, Joy Zhao, MD², Julietta Gervase, BA¹, Joria Le, RN, BSN², Marcel Robles, MD², Anand Kumar, MD, MPH², Alexander Schlachterman, MD¹. P1022 - Same Day Discharge vs Overnight Admission for Outpatient Esophageal Per-Oral Endoscopic Myotomy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.