Comment on: "Evaluation of adverse events following endoscopic peroral myotomy (POEM) for achalasia � Implications for feasibility of same-day discharge"

Calm et al. retrospectively evaluated adverse events (AE) in 76 patients undergoing peroral endoscopic myotomy (POEM) for achalasia and proposed that 87-90% could be candidates for same-day discharge (SDD). We highlight two methodological concerns: the wide confidence interval (95% CI 3.06-1219.86) around the sole independent predictor of grade ≥II AE, based on only 4 events, and the retrospective nature of the SDD eligibility estimate, since all patients in the cohort were actually admitted overnight. We also note that tolerance of oral analgesia, a criterion used in existing SDD protocols, could not be assessed in this study. We suggest that prospective validation incorporating this criterion is needed before the reported eligibility rate is applied to routine practice.