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

Rym El Khoury*, Ezra Nathaniel Teitelbaum, Joel M. Sternbach, Nathaniel J Soper, Carla Harmath, John Erik Pandolfino, Peter J Kahrilas, Eric Hungness

*Corresponding author for this work

Research output: Contribution to journalArticle

15 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

Keywords

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

ASJC Scopus subject areas

  • Surgery

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