Clinical impact of routine esophagram after peroral endoscopic myotomy.
Journal
Gastrointestinal endoscopy
ISSN: 1097-6779
Titre abrégé: Gastrointest Endosc
Pays: United States
ID NLM: 0010505
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
06
04
2020
accepted:
08
05
2020
pubmed:
7
6
2020
medline:
1
6
2021
entrez:
7
6
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32504702
pii: S0016-5107(20)34396-0
doi: 10.1016/j.gie.2020.05.046
pmc: PMC8783294
mid: NIHMS1769672
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
102-106Subventions
Organisme : NIDDK NIH HHS
ID : P30 DK123704
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
Références
Neurogastroenterol Motil. 2015 Feb;27(2):160-74
pubmed: 25469569
Gastroenterology. 2017 Nov;153(5):1205-1211
pubmed: 28989059
Gastrointest Endosc. 2010 Mar;71(3):446-54
pubmed: 20189503
Gastrointest Endosc. 2016 Sep;84(3):408-15
pubmed: 26907745
Ann Surg. 2014 Jun;259(6):1098-103
pubmed: 24169175
Surg Endosc. 2018 Jan;32(1):421-427
pubmed: 28664434
Dig Endosc. 2016 Jan;28(1):27-32
pubmed: 26108140
Gastrointest Endosc. 2017 Jun;85(6):1208-1211
pubmed: 27756611
JAMA. 2019 Jul 9;322(2):134-144
pubmed: 31287522
Am J Gastroenterol. 2013 Aug;108(8):1238-49; quiz 1250
pubmed: 23877351
J Gastrointest Surg. 2016 Nov;20(11):1789-1796
pubmed: 27514392
Gastrointest Endosc. 2019 Oct;90(4):570-578
pubmed: 31078571
Surg Endosc. 2016 Jul;30(7):2969-74
pubmed: 26487213
Surg Endosc. 2013 Sep;27(9):3322-38
pubmed: 23549760
Surgery. 2015 Oct;158(4):1128-35; discussion 1135-6
pubmed: 26189954
Endosc Int Open. 2015 Jun;3(3):E195-201
pubmed: 26171430
N Engl J Med. 2019 Dec 5;381(23):2219-2229
pubmed: 31800987
Gastrointest Endosc. 2014 Dec;80(6):1046-55
pubmed: 24998467
Surgery. 2013 Oct;154(4):885-91; discussion 891-2
pubmed: 24074428
Am J Gastroenterol. 2017 Aug;112(8):1267-1276
pubmed: 28534521
Ann Surg. 2016 Sep;264(3):508-17
pubmed: 27513156