Evaluation of the need for routine esophagram after peroral endoscopic myotomy (POEM)

Rym El Khoury, Ezra N. Teitelbaum, Joel M. Sternbach, Nathaniel J. Soper, Carla B. Harmath, John E. Pandolfino, Peter J. Kahrilas, Eric S. Hungness

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Background: Peroral endoscopic myotomy (POEM) is a novel surgical option for the treatment of achalasia. Most centers perform a routine esophagram on postoperative day (POD) #1 to rule esophageal perforation and leaks. In this study, we sought to determine the clinical utility of routine contrast studies post-POEM. Methods: POEM was performed using an anterior submucosal tunnel and selective myotomy of the circular muscle layer. A routine contrast esophagram was obtained on POD #1. We conducted a retrospective review of the radiologists’ interpretations of these studies and compared them to patient’s clinical course. Results: Seventy-eight patients were included. Among these, two complications occurred. One patient was non-compliant with postoperative nil per os orders and developed epigastric pain suspicious for a leak that was demonstrated on esophagram. Another patient had subcutaneous emphysema on POD #1 esophagram, a finding that was also present on physical examination, without esophageal leakage. Another esophagram in an asymptomatic patient was suspicious for submucosal tunnel hematoma which prompted a return to the operating room with negative results. Overall, 56 patients had abnormal studies. POD #1 esophagram demonstrated a sensitivity of 100 % and specificity of 45 % in identifying clinically significant complications. Conclusions: In this series, we found routine esophagram to have a high sensitivity but a very low specificity in detecting clinically significant complications. Routine esophagram after POEM may not be necessary.

Original languageEnglish (US)
Pages (from-to)2969-2974
Number of pages6
JournalSurgical endoscopy
Volume30
Issue number7
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

Keywords

  • Achalasia
  • Esophageal leak
  • Esophageal physiology
  • Esophagram
  • Peroral endoscopic myotomy
  • Postoperative complications

ASJC Scopus subject areas

  • Surgery

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