Background and Aims
Peroral endoscopic myotomy (POEM) is a procedure with potential for serious adverse
events. Postprocedure imaging is routinely done, yet there is no consensus on the
optimal imaging protocol. We describe a novel and simple CT esophagram protocol for
evaluation after POEM and for reporting the full spectrum of radiographic findings
and subsequent interventions.
Methods
This was a single-center prospective study of consecutive patients treated with POEM
evaluated with CT esophagram.
Results
Eighty-four consecutive patients who had POEM performed underwent CT esophagrams.
The most common findings were pneumomediastinum (85.7%), pneumoperitoneum (66.7%),
subcutaneous emphysema (52.4%), and pleural effusion (46.4%). Other findings included
retroperitoneal air (38.1%), pneumothorax (19%), atelectasis (14.3%), intramural air
in the esophagus and/or stomach (13.1%), pericardial effusion (2.4%), and pneumopericardium
(2.4%). Five patients required intervention based on CT findings. In 1 patient, a
leak was detected on CT esophagram before any clinical manifestation, facilitating
prompt intervention and avoiding potential serious outcomes. Four patients were diagnosed
with pneumonia and were treated with antibiotics. There was frequent postprocedural
atelectasis, which prompted the introduction of routine incentive spirometry in all
postoperative POEM cases.
Conclusions
CT esophagram is a simple and accessible imaging test for routine postoperative POEM
evaluation. Numerous and dramatic postprocedure radiographic findings may be expected
and demonstrated with this imaging modality. Although most of these findings may not
require intervention, some are of potential significance, and early identification
may help modify postprocedure management. (Clinical trial registration number: NCT01832779.)
Abbreviation:
POEM (peroral endoscopic myotomy)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 21, 2016
Accepted:
February 10,
2016
Received:
October 26,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
