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

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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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Acknowledgments

The authors would like to acknowledge Rowena Martinez, RN, and Colleen Krantz, RN, for their help coordinating the clinical aspects of this study.

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Authors and Affiliations

  1. Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 650, Chicago, IL, 60611, USA

    Rym El Khoury, Ezra N. Teitelbaum, Joel M. Sternbach, Nathaniel J. Soper & Eric S. Hungness

  2. Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Carla B. Harmath

  3. Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    John E. Pandolfino & Peter J. Kahrilas

Authors
  1. Rym El Khoury
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  2. Ezra N. Teitelbaum
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  3. Joel M. Sternbach
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  4. Nathaniel J. Soper
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  5. Carla B. Harmath
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  6. John E. Pandolfino
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  7. Peter J. Kahrilas
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  8. Eric S. Hungness
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Corresponding author

Correspondence to Rym El Khoury.

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Disclosures

Eric Hungness receives an honorarium for educational activities from Baxter, which is unrelated to this study. Nathaniel Soper is on the scientific advisory boards of TransEnterix and Miret Surgical, which are unrelated to this study. Ezra Teitelbaum, Joel Sternbach, John Pandolfino, Peter Kahrilas, Carla Harmath, and Rym El Khoury have no conflicts of interest or financial ties to disclose.

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El Khoury, R., Teitelbaum, E.N., Sternbach, J.M. et al. Evaluation of the need for routine esophagram after peroral endoscopic myotomy (POEM). Surg Endosc 30, 2969–2974 (2016). https://doi.org/10.1007/s00464-015-4585-z

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  • DOI: https://doi.org/10.1007/s00464-015-4585-z

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