Meglumine diatrizoate esophagogram after peroral endoscopic myotomy (POEM): identification of imaging findings associated with clinical complications and longer hospital stay.
Adult
Aged
Contrast Media
Diatrizoate Meglumine
Esophageal Achalasia
/ surgery
Esophageal Motility Disorders
/ diagnostic imaging
Esophagus
/ diagnostic imaging
Female
Humans
Length of Stay
Male
Middle Aged
Myotomy
/ adverse effects
Natural Orifice Endoscopic Surgery
/ adverse effects
Pneumoperitoneum
/ diagnostic imaging
Postoperative Complications
/ diagnostic imaging
Retrospective Studies
Treatment Outcome
Achalasia
Esophageal motility disorders
Esophageal perforation
Meglumine diatrizoate esophagogram
Peroral endoscopic myotomy (POEM)
Journal
European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
09
01
2020
accepted:
17
02
2020
revised:
05
02
2020
pubmed:
15
3
2020
medline:
17
12
2020
entrez:
15
3
2020
Statut:
ppublish
Résumé
Esophageal peroral endoscopic myotomy (POEM) is the treatment of reference of major obstructive esophageal motility disorders but the detection of early complications remains challenging. Our aim was to report the radiological findings on meglumine diatrizoate esophagograms after esophageal POEM and identify variables associated with patient outcomes. The imaging and clinical files of 106 patients who underwent POEM for achalasia or other major obstructive esophageal motility disorders were retrospectively analyzed. Post POEM esophagograms were reviewed for the presence of pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips. Associations between length of hospital stay and radiological findings were searched for using a Cox multivariate analysis. A total of 106 patients (M/F = 56/50; mean age = 50 ± 2 [SD] years) underwent 106 POEM procedures with a meglumine diatrizoate esophagogram on postoperative day 1. Overall median hospital stay was 3 days (range 1-20 days). Pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips were observed in 90/106 (84.9%), 12/106 (11.3%), 4/106 (3.8%), and 0/106 (0%) patients, respectively. At multivariate analysis, pleural effusion (p = 0.005; adjusted hazard ratio [aHR] = 0.35 [95% CI 0.17-0.73]) and extraesophageal contrast leakage (p = 0.039; aHR = 0.27 [95% CI 0.08-0.94]) were associated with a prolonged hospital stay. Pneumoperitoneum was not associated with unfavorable outcome (p = 0.99). Pneumoperitoneum is a common finding after POEM and is not indicative of unfavorable patient outcome. Conversely, post POEM pleural effusion and extraesophageal contrast leakage are associated with a longer hospital stay. • Water-soluble esophagogram is a valid diagnostic modality to diagnose early complications after esophageal endoscopic myotomy for esophageal motility disorders. • At multivariate analysis, pleural effusion and extraesophageal contrast leakage are associated with a prolonged hospital stay after peroral endoscopic myotomy. • Pneumoperitoneum is not associated with unfavorable outcome after peroral endoscopic myotomy.
Identifiants
pubmed: 32170414
doi: 10.1007/s00330-020-06758-0
pii: 10.1007/s00330-020-06758-0
doi:
Substances chimiques
Contrast Media
0
Diatrizoate Meglumine
3X9MR4N98U
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4175-4181Références
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