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20.10.2015 | Ausgabe 7/2016

Surgical Endoscopy 7/2016

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

Zeitschrift:
Surgical Endoscopy > Ausgabe 7/2016
Autoren:
Rym El Khoury, Ezra N. Teitelbaum, Joel M. Sternbach, Nathaniel J. Soper, Carla B. Harmath, John E. Pandolfino, Peter J. Kahrilas, Eric S. Hungness
Wichtige Hinweise
Presented at EAES: Oral presentation – Abstract code 0052. June 26, 2014.

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.

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