Prospective Evaluation of CT Esophagram Findings after Peroral Endoscopic Myotomy.

Related Articles

Prospective Evaluation of CT Esophagram Findings after Peroral Endoscopic Myotomy.

Gastrointest Endosc. 2016 Feb 20;

Authors: Pannu D, Yang D, Abbitt PL, Draganov PV

Abstract
BACKGROUND AND AIMS: 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 post-POEM evaluation and report the full spectrum of radiographic findings and subsequent interventions.
METHODS: Single-center prospective study of consecutive patients treated with POEM evaluated with CT esophagram.
RESULTS: Eighty-four consecutive post-POEM patients underwent CT esophagram. 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/stomach (13.1%), pericardial effusion (2.4%), and pneumopericardium (2.4%). Five patients required intervention based on CT findings. In one patient, a leak was detected on CT esophagram before any clinical manifestation; facilitating prompt intervention and avoiding potential serious outcome. Four patients were diagnosed with pneumonia and treated with antibiotics. There was frequent postprocedural atelectasis, which prompted the introduction of routine incentive spirometry in all post-POEM cases.
CONCLUSION: CT esophagram is a simple and accessible imaging test for routine post-POEM evaluation. Numerous and dramatic postprocedure radiographic findings may be expected and demonstrated with this imaging modality. Although most of these findings may not require intervention, some are of potential significance, and early identification may help modify post-procedure management.

PMID: 26907745 [PubMed - as supplied by publisher]

from #ENT-PubMed via ola Kala on Inoreader http://ift.tt/1TD3tR4
via IFTTT