Same Day Discharge vs. Overnight Admissions for Outpatient Esophageal Per-Oral Endoscopic Myotomy (E-POEM)

Purpose: Esophageal Peroral Endoscopic Myotomy (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 preprocedural factors and clinical outcomes associated with SDD compared to OA. Methods: This is a retrospective analysis of patient demographics, pre-, intra-, and postprocedural characteristics, and procedure charges of patients who received outpatient E-POEM at a single institution. Results: 218 patients underwent outpatient E-POEM (36 SDD, 182 OA). Technical success was 100%. There were no statistically significant differences in prior Heller myotomy or procedure length (p = 0.979, 0.534). SDD patients were younger on average (54.1 vs 62.4, p = 0.0068), had fewer afternoon procedures (p = 0.0194), and were less likely to require postprocedural opioids (p = 0.00114). Average times of day for esophagrams performed the day of the procedure were 1515 and 1508 in the SDD and OA groups, respectively, and 1035 when performed the day after the 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 $6,799 and $7,942 in the OA group (p = 0.171). Discussion: SDD was associated with younger patients, morning procedures, and lower opiate usage. Costs trended lower for SDD, though the difference was not statistically significant in our sample. Standardizing morning E-POEMs with same day post-procedural esophagrams may facilitate SDD for patients who do not require opiates for pain control.