Preoperative Prognostic Nutritional Index and Perioperative Adverse Events After Peroral Endoscopic Myotomy for Achalasia: A Retrospective Two-Center Cohort Study
Makaleler > Tam Makale · 2026
Yazarlar: Ali Cagatay Bozkina, �agdas Erdogan, Asuman SARGIN, Ali Mert, Abdullah Murat BUYRUK
Revista Española de Enfermedades Digestivas, Uluslararası, Wos, 2026
DOI: 10.17235/reed.2026.11998/2026
Özet
BACKGROUND AND AIM: Peroral endoscopic myotomy is an effective treatment for achalasia, but perioperative adverse events may occur. The prognostic nutritional index reflects nutritional and immune status; however, its role in perioperative risk assessment after peroral endoscopic myotomy remains unclear. This study aimed to explore the association between preoperative prognostic nutritional index and clinical outcomes after peroral endoscopic myotomy for achalasia. METHODS: This retrospective two-center cohort study included 340 adult patients who underwent peroral endoscopic myotomy for achalasia between January 2022 and October 2025. Demographic, clinical, laboratory, and procedural data were reviewed. The primary outcome was any perioperative adverse event within 30 days after the procedure, including pneumoperitoneum, bleeding, emphysema, and mucosal injury. Secondary outcomes were length of hospital stay and time to initiation of oral feeding. Factors associated with adverse events were assessed using multivariable logistic regression. RESULTS: Perioperative adverse events occurred in 133 patients (39.1%). Pneumoperitoneum was the most common event, occurring in 104 patients (30.6%). Preoperative prognostic nutritional index did not differ significantly between patients with and without adverse events in univariable comparison. In the forward conditional multivariable logistic regression analysis, longer symptom duration (p=0.025), higher Charlson Comorbidity Index (p=0.014), and sex (p<0.001) were retained in the final model, whereas preoperative PNI was not retained. In the supplementary forced-entry model, preoperative PNI remained not independently associated with perioperative adverse events after adjustment for clinically relevant covariates (adjusted OR 1.003, 95% CI 0.969-1.037; p=0.883). Prognostic nutritional index was not significantly associated with length of hospital stay or timing of oral feeding. CONCLUSIONS: Preoperative PNI was not independently associated with perioperative adverse events or secondary outcomes after POEM. Longer symptom duration, higher Charlson Comorbidity Index, and patient sex were independently associated with adverse events, whereas the role of PNI remains exploratory and requires prospective validation.