Pulmonary embolism as an early sequel of per oral endoscopic myotomy (PoeM) for treatment of achalasia : to anticoagulate or not?

Per Oral Endoscopic Myotomy (PoeM) was introduced by Inuoe et al as a treatment of achalasia in 2010 (1). Several long-term outcome studies showed satisfactory results for PoeM; technical success was approximately 97%, and clinical success ranged from 93% to 98% (2). The complications encountered usually represent a small percentage in various studies ranging from 0% to 13% (3). The complications are mostly related to air leak during the myotomy step, presenting as subcutaneous emphysema, pneumoperitoneum, pneumomediastinum or less likely pneumothorax (4). They may also be related to injuries during the procedure, including mucosal injury, significant bleeding or, less likely, oesophageal perforation (5).