Prospective evaluation of CT esophagram findings after peroral endoscopic myotomy

Gastrointestinal Endoscopy
Davinderbir PannuPeter V Draganov

Abstract

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. This was a single-center prospective study of consecutive patients treated with POEM evaluated with CT esophagram. 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 at...Continue Reading

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Citations

Feb 13, 2018·Current Treatment Options in Gastroenterology·Dennis Yang, Peter V Draganov
Aug 26, 2017·Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology·Santosh DarisettyD Nageshwar Reddy
Aug 28, 2019·Digestive Diseases and Sciences·Mitchell S CappellDavid Friedel
Jun 3, 2020·Endoscopy·Rachel HallitStanislas Chaussade
Feb 13, 2021·Radiographics : a Review Publication of the Radiological Society of North America, Inc·Ashley A Norton-GregoryStephane L Desouches
Nov 12, 2020·Clinical and Experimental Gastroenterology·Pravallika ChadalavadaMadhusudhan R Sanaka

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