Clinical impact of routine CT esophagogram after peroral endoscopic myotomy (POEM) for esophageal motility disorders

Marion Chartier; Maxime Barat; Anthony Dohan; Arthur Belle; Ammar Oudjit; Einas Abou Ali; Rachel Hallit; Chloé Leandri; Sophie Scialom; Romain Coriat; Stanislas Chaussade; Philippe Soyer; Maximilien Barret

doi:10.1055/a-1512-9638

Clinical impact of routine CT esophagogram after peroral endoscopic myotomy (POEM) for esophageal motility disorders

Endosc Int Open. 2021 Aug 16;9(9):E1355-E1360. doi: 10.1055/a-1512-9638. eCollection 2021 Sep.

Authors

Marion Chartier¹, Maxime Barat^{2

3}, Anthony Dohan^{2

3}, Arthur Belle¹, Ammar Oudjit², Einas Abou Ali^{1

3}, Rachel Hallit¹, Chloé Leandri¹, Sophie Scialom¹, Romain Coriat^{1

3}, Stanislas Chaussade^{1

3}, Philippe Soyer^{2

3}, Maximilien Barret^{1

3}

Affiliations

¹ Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
² Department of Abdominal and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
³ Université de Paris, Paris, France.

Abstract

Background and study aims Per oral endoscopic myotomy (POEM) of the lower esophageal sphincter has become a major treatment for esophageal motility disorders, especially achalasia. POEM can result in esophageal bleeding or perforation and pleural and mediastinal effusion. Early routine computed tomography (CT) esophagogram is frequently performed to assess these adverse events (AEs) before resuming oral food intake. We sought to evaluate the value of routine CT esophagogram on postoperative day (POD) 1 after POEM. Patients and methods This single-center retrospective study was performed in a tertiary referral center for interventional digestive endoscopy. We included consecutive patients with POEM and routine CT esophagogram on POD 1 between July 2018 and July 2019. Results Fifty-eight patients were included in the study, 79 % of whom had achalasia. Twenty patients (34 %) presented post-endoscopic AEs, including two patients with severe AEs requiring intensive care admission (one compressive pneumothorax and one mediastinitis); no deaths occurred. Of the 58 CT esophagograms performed, only one was normal. The 57 others (98 %) showed at least one abnormal finding: pneumoperitoneum or retroperitoneal air (91 %), pneumomediastinum (78 %), pleural effusion (34 %), pneumothorax (14 %), pneumonia (7 %), pericardial effusion (2 %), and mediastinal collection (2 %). CT esophagograms revealed AEs and modified therapeutic management in eight patients of 58 (14 %), all of whom had clinical symptoms prior to CT. Conclusions POD 1 CT esophagogram after POEM for esophageal motility disorders diagnosed clinically meaningful AEs in 14 % of patients, all associated with persistent clinical symptoms. Routine use of CT esophagogram after POEM in asymptomatic patients is questionable.

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