Clinical Impact of Routine Computed Tomography Esophagogram after Peroral Endoscopic Myotomy for Esophageal Motility Disorders

Aim: Peroral endoscopic myotomy (POEM) of the lower esophageal sphincter is an established treatment modality for various esophageal motility disorders, especially achalasia cardia. Although safe it can be associated with major and minor adverse events (AEs). Postprocedure computed tomography (CT) esophagogram is frequently performed for early diagnosis of AEs. We aimed to evaluate the utility of routine CT esophagogram after POEM.

Methods: This retrospective study was performed at two tertiary referral centers from June 2023 to January 2024. All consecutive patients with POEM and routine CT esophagogram on post operative day (POD) 1 were included in the study.

Results: Fifty-four consecutive patients were included in the study, 96% of whom had achalasia cardia. POEM was technically feasible in all patients. Mucosal blebs occurred in four patients (4/54; 7.4%) and pneumoperitoneum requiring decompression in three patients (3/54; 5.5%). Subcutaneous emphysema without any therapeutic consequence were seen in 11 patients (11/54; 20%). Of 54 CT esophagograms done, only three were normal. The 51 others (94%) showed at least one abnormal finding: minimal pleural effusion (29/54; 53.7%), pneumoperitoneum (20/54; 37%), pneumomediastinum (16/54; 29.6%), pneumonia (6/54; 11%) including one infected cystic bronchiectasis, pneumothorax (4/54; 7.4%), esophageal perforation (1/54: 1.8%), contrast leak into submucosal tunnel (1/54; 1.8%), mediastinal collection (1/54; 1.8%). CT esophagogram modified therapeutic management in three patients (infected cystic bronchiectasis, esophageal perforation and contrast leak into submucosal tunnel) of 54 (5.6%), out of which former two had clinical symptom prior to CT.

Conclusions: Routine POD1 CT esophagogram after POEM diagnosed clinically meaningful AEs in 5.6% of patients, most of whom had persistent clinical symptoms. Routine use of CT esophagogram after POEM is of questionable benefit.

Publication History

Article published online:
22 April 2024