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SINGLE-BLINDED RANDOMIZED CONTROLLED TRIAL COMPARING THE EFFECT OF UNDERWATER VERSUS CARBON DIOXIDE INSUFFLATION DURING PERORAL ENDOSCOPIC MYOTOMY ON POST-PROCEDURAL PAIN (U-POEM TRIAL)
Journal article   Peer reviewed

SINGLE-BLINDED RANDOMIZED CONTROLLED TRIAL COMPARING THE EFFECT OF UNDERWATER VERSUS CARBON DIOXIDE INSUFFLATION DURING PERORAL ENDOSCOPIC MYOTOMY ON POST-PROCEDURAL PAIN (U-POEM TRIAL)

Dennis Yang, Peter V. Draganov, Maham Hayat, Abdullah Abbasi, Saurabh Chandan, Sagar J. Pathak, Muhammad K. Hasan, Carlos Bertran-Rodriguez, Zubair Khan, Abdul Sattar Shariq Mohammed, …
Gastrointestinal endoscopy
07/06/2026
DOI: 10.1016/j.gie.2026.06.066
PMID: 42409294

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Abstract

“Underwater” endoscopic techniques have gained traction given its potential advantages. The aim of this multicenter randomized trial was to compare the effect of saline immersion (U-POEM) vs. carbon dioxide insufflation during peroral endoscopic myotomy (CO2-POEM) on post-procedural pain. Consecutive patients with achalasia subtype I and II were randomized in a 1:1 ratio to U-POEM or CO2-POEM during the study period between February 2025 to November 2025. Pain was assessed using the validated numeric pain rating (NPRS) on a scale of 0 (none) to 10 (most severe). Primary outcome was immediate post-procedure pain. Secondary outcomes included: post-procedure pain at different time periods, requirement of analgesics, and clinical response (defined as a post-POEM Eckardt score <3). Thirty-six patients were randomized to U-POEM (n=18) and CO2-POEM (n=18). Technical and clinical success were 100% in both groups with no immediate and delayed adverse events. There were no differences in dissection speed or procedural time between the two groups. The immediate post-POEM mean NPRS score was significantly lower in the U-POEM vs. CO2-POEM group (1.6 ± 1.6 vs. 3.3 ± 2.6; 95% CI: 0.23-3.16; p=0.02). When compared to CO2-POEM, patients who underwent U-POEM reported less moderate-severe pain (16.7% vs. 55.5%; 95% CI: 0.04-0.64; p=0.04) and a lower number required opioids for post-operative pain management (5.5% vs. 50%; 95% CI: 0.11-0.68; p=0.007). Mean NPRS score remained lower in the U-POEM vs. CO2-POEM group at 72-hours after the procedure (1.13±1.36 vs. 2.26±1.78; 95% CI: 0.06-2.20; p=0.04). U-POEM was safe, effective, and associated with lower post-procedure pain scores when compared to CO2-POEM (U-POEM trial:NCT06918730).

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