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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(09): E1355-E1360
DOI: 10.1055/a-1512-9638
Original article

Clinical impact of routine CT esophagogram after peroral endoscopic myotomy (POEM) for esophageal motility disorders

Marion Chartier
1   Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
,
Maxime Barat
2   Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
3   Université de Paris, Paris, France
,
Anthony Dohan
2   Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
3   Université de Paris, Paris, France
,
Arthur Belle
1   Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
,
Ammar Oudjit
2   Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
,
Einas Abou Ali
1   Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
3   Université de Paris, Paris, France
,
Rachel Hallit
1   Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
,
Chloé Leandri
1   Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
,
Sophie Scialom
1   Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
,
Romain Coriat
1   Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
3   Université de Paris, Paris, France
,
Stanislas Chaussade
1   Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
3   Université de Paris, Paris, France
,
Philippe Soyer
2   Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
3   Université de Paris, Paris, France
,
Maximilien Barret
1   Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
3   Université de Paris, Paris, France
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Abstract

Background and study aims Per oral endoscopic myotomy (POEM) of the lower esophageal sphincter has become a major treatment for esophageal motility disorders, especially achalasia. POEM can result in esophageal bleeding or perforation and pleural and mediastinal effusion. Early routine computed tomography (CT) esophagogram is frequently performed to assess these adverse events (AEs) before resuming oral food intake. We sought to evaluate the value of routine CT esophagogram on postoperative day (POD) 1 after POEM.

Patients and methods This single-center retrospective study was performed in a tertiary referral center for interventional digestive endoscopy. We included consecutive patients with POEM and routine CT esophagogram on POD 1 between July 2018 and July 2019.

Results Fifty-eight patients were included in the study, 79 % of whom had achalasia. Twenty patients (34 %) presented post-endoscopic AEs, including two patients with severe AEs requiring intensive care admission (one compressive pneumothorax and one mediastinitis); no deaths occurred. Of the 58 CT esophagograms performed, only one was normal. The 57 others (98 %) showed at least one abnormal finding: pneumoperitoneum or retroperitoneal air (91 %), pneumomediastinum (78 %), pleural effusion (34 %), pneumothorax (14 %), pneumonia (7 %), pericardial effusion (2 %), and mediastinal collection (2 %). CT esophagograms revealed AEs and modified therapeutic management in eight patients of 58 (14 %), all of whom had clinical symptoms prior to CT.

Conclusions POD 1 CT esophagogram after POEM for esophageal motility disorders diagnosed clinically meaningful AEs in 14 % of patients, all associated with persistent clinical symptoms. Routine use of CT esophagogram after POEM in asymptomatic patients is questionable.



Publication History

Received: 14 January 2021

Accepted: 10 May 2021

Article published online:
16 August 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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