Anesthetic challenges in peroral endoscopic myotomy (POEM) in bizarre parosteal osteochondromatous proliferation (Nora lesion)

Abstract

Peroral endoscopic myotomy (POEM) is a novel technique that utilizes natural orifice transluminal endoscopy to address esophageal motility disorders. This method, which is performed under general anesthesia in an endoscopy suite, has shown effectiveness similar to that of Heller myotomy. A pivotal part of the POEM procedure involves the creation of a submucosal tunnel within the esophageal wall. However, the ongoing insufflation of CO? can inadvertently extend into nearby tissues, leading to Complications such as capnomediastinum, capnothorax, capnoperitoneum, and subcutaneous emphysema. An anesthesiologist faces several challenges, including administering anesthesia in remote locations, managing the heightened risk of aspiration during induction, and promptly identifying and addressing these complications with specific emergency measures. Consequently, the anesthesiologist on duty must be knowledgeable about these frequent complications and the necessary emergency responses, such as compensatory hyperventilation, percutaneous needle decompression, and thoracic drainage. While peroral endoscopic myotomy (POEM) is generally conducted under general anesthesia, there is a scarcity of reports that elaborate on its anesthetic management and associated complications.

Keywords: POEM, NORA, Aspiration, ventilation

Citation: Ubhe S, Khatri S, Nagrik R. Anesthetic challenges in peroral endoscopic myotomy (POEM) in bizarre parosteal osteochondromatous proliferation (Nora lesion). Anaesth. pain intensive care 2026;30(3):377-379. DOI: 10.35975/apic.v30i3.3180

Received: Sep 09, 2025, Revised: November 25, 2025, Accepted: December 06, 2025