TY - JOUR
T1 - Early esophagram in per-oral endoscopic myotomy (POEM) for Achalasia does not predict long-term outcomes
AU - Sternbach, Joel M.
AU - El Khoury, Rym
AU - Teitelbaum, Ezra N.
AU - Soper, Nathaniel J.
AU - Pandolfino, John E.
AU - Hungness, Eric S.
N1 - Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Background In the recently reported international survey of centers performing per-oral endoscopic myotomy (POEM), 88% of operators reported obtaining routinely an early postoperative contrast esophagram. To date, there have been no studies to assess the prognostic value of early esophagram in POEM. Methods A retrospective review of a prospectively maintained, single-institution database of patients who underwent POEM for treatment of achalasia was conducted. Patients were evaluated with a routine contrast esophagram on the first postoperative day (POD#1) to assess for perforation. The finding of delayed esophageal emptying, as determined by an attending radiologist, was compared with the patients' symptomatic outcomes and functional parameters at one year follow-up. Results Contrast esophagram was obtained on POD#1 for 72 patients undergoing POEM; 26 patients (36%) were observed to have a delay in esophageal emptying. Both groups of patients, those with a delay and those without a delay in esophageal emptying on POD#1, had similar preoperative Eckardt scores (7 ± 2 vs 7 ± 2, P = ns) and column height at 5 minutes on preoperative timed barium esophagram (12.1 ± 8 cm vs 14.1 ± 8 cm, P = ns). At a mean follow-up of 1 year, there was no difference in Eckardt scores between patients with and those without a delay in emptying on POD#1 esophagram (1 ± 2 vs 1 ± 1, P = ns), nor was there a difference between the 2 groups in column height at 5 minutes on TBE (5.5 ± 5 cm for delay vs 4.2 ± 4 cm for no delay; P = ns). Rates of treatment failure, as measured by Eckardt score >3 or need for subsequent treatment, also did not differ between the 2 groups (3 patients with delay vs 4 patients without delay in emptying, P = ns). Conclusion Delay in passage of contrast on POD#1 esophagram did not predict symptomatic or physiologic outcomes at 1-year follow-up in patients undergoing POEM for treatment of achalasia.
AB - Background In the recently reported international survey of centers performing per-oral endoscopic myotomy (POEM), 88% of operators reported obtaining routinely an early postoperative contrast esophagram. To date, there have been no studies to assess the prognostic value of early esophagram in POEM. Methods A retrospective review of a prospectively maintained, single-institution database of patients who underwent POEM for treatment of achalasia was conducted. Patients were evaluated with a routine contrast esophagram on the first postoperative day (POD#1) to assess for perforation. The finding of delayed esophageal emptying, as determined by an attending radiologist, was compared with the patients' symptomatic outcomes and functional parameters at one year follow-up. Results Contrast esophagram was obtained on POD#1 for 72 patients undergoing POEM; 26 patients (36%) were observed to have a delay in esophageal emptying. Both groups of patients, those with a delay and those without a delay in esophageal emptying on POD#1, had similar preoperative Eckardt scores (7 ± 2 vs 7 ± 2, P = ns) and column height at 5 minutes on preoperative timed barium esophagram (12.1 ± 8 cm vs 14.1 ± 8 cm, P = ns). At a mean follow-up of 1 year, there was no difference in Eckardt scores between patients with and those without a delay in emptying on POD#1 esophagram (1 ± 2 vs 1 ± 1, P = ns), nor was there a difference between the 2 groups in column height at 5 minutes on TBE (5.5 ± 5 cm for delay vs 4.2 ± 4 cm for no delay; P = ns). Rates of treatment failure, as measured by Eckardt score >3 or need for subsequent treatment, also did not differ between the 2 groups (3 patients with delay vs 4 patients without delay in emptying, P = ns). Conclusion Delay in passage of contrast on POD#1 esophagram did not predict symptomatic or physiologic outcomes at 1-year follow-up in patients undergoing POEM for treatment of achalasia.
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U2 - 10.1016/j.surg.2015.05.023
DO - 10.1016/j.surg.2015.05.023
M3 - Article
C2 - 26189954
AN - SCOPUS:84940797506
SN - 0039-6060
VL - 158
SP - 1128
EP - 1136
JO - Surgery (United States)
JF - Surgery (United States)
IS - 4
ER -