Background and Aims

It is unclear whether the common practice of postoperative day (POD) 1 esophagram impacts clinical care or reliably identifies significant adverse events (AEs) related to peroral endoscopic myotomy (POEM). Therefore, we aimed to correlate the most clinically relevant esophagram findings with postoperative outcomes after POEM.

Methods

Patients were retrospectively reviewed and included if they underwent POEM at 1 of the 3 study institutions between 2014 and 2018. Patient outcomes were assessed in relation to relevant POD 1 esophagram findings such as esophageal dissection or leak.

Results

One hundred seventy post-POEM contrast esophagrams (139 fluoroscopy-based vs 31 CT-based) performed on POD 1 were included. Most esophagrams (n = 98) contained abnormal findings but only 5 showed esophageal leak or dissection. Confirmed postoperative AEs of leak or dissection occurred in 4 patients. In 2 patients, POD 1 esophagram appropriately identified the leak or dissection, but in the other 2 patients the initial esophagram was negative, and the AEs were not recognized before clinical deterioration. One patient had a false-positive leak and dissection noted on esophagram leading to an unremarkable endoscopy.

Conclusions

Despite the low AE rate after POEM, follow-up esophagram on POD 1 frequently shows expected, unremarkable postprocedural findings and occasionally fails to diagnose serious AEs. This results in pitfalls in accuracy regarding agreement between esophagram versus clinical and endoscopic findings. Relying exclusively on esophagram for post-POEM clinical decision-making can lead to unnecessary additional testing or missed AEs.

中文翻译：

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经口内镜下肌切开术后常规食管造影的临床影响。

背景和目标

目前尚不清楚术后第 1 天 (POD) 食管造影的常见做法是否会影响临床护理或可靠地识别与经口内镜下肌切开术 (POEM) 相关的重大不良事件 (AE)。因此，我们旨在将临床上最相关的食管造影结果与 POEM 后的术后结果相关联。

方法

如果患者在 2014 年至 2018 年期间在 3 个研究机构中的 1 个接受过 POEM，则对患者进行回顾性审查。根据相关 POD 1 食管检查结果（例如食管夹层或渗漏）评估患者结果。

结果

包括在 POD 1 上进行的 170 张 POEM 后对比食管图（139 份基于透视，31 份基于 CT）。大多数食管照片（n = 98）包含异常发现，但只有 5 例显示食管渗漏或夹层。4 名患者发生经证实的术后渗漏或夹层 AE。在 2 名患者中，POD 1 食管造影适当地确定了渗漏或夹层，但在另外 2 名患者中，初始食管造影为阴性，并且在临床恶化之前未发现 AE。一名患者出现假阳性渗漏，食管造影显示夹层，导致内窥镜检查不显着。

结论

尽管 POEM 后的 AE 发生率较低，但 POD 1 的后续食管造影经常显示预期的、不显着的术后发现，并且偶尔无法诊断出严重的 AE。这导致食管图与临床和内窥镜检查结果之间一致性的准确性存在缺陷。完全依赖食管图进行 POEM 后临床决策可能会导致不必要的额外测试或遗漏 AE。