PMID- 32504702
OWN - NLM
STAT- MEDLINE
DCOM- 20210531
LR  - 20220124
IS  - 1097-6779 (Electronic)
IS  - 0016-5107 (Print)
IS  - 0016-5107 (Linking)
VI  - 93
IP  - 1
DP  - 2021 Jan
TI  - Clinical impact of routine esophagram after peroral endoscopic myotomy.
PG  - 102-106
LID - S0016-5107(20)34396-0 [pii]
LID - 10.1016/j.gie.2020.05.046 [doi]
AB  - 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.
CI  - Copyright (c) 2021 American Society for Gastrointestinal Endoscopy. Published by 
      Elsevier Inc. All rights reserved.
FAU - Reddy, Chanakyaram A
AU  - Reddy CA
AD  - Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
FAU - Tavakkoli, Anna
AU  - Tavakkoli A
AD  - Division of Gastroenterology, UT Southwestern, Dallas, Texas, USA.
FAU - Abdul-Hussein, Mustafa
AU  - Abdul-Hussein M
AD  - Division of Gastroenterology, Medical University of South Carolina, Charleston, 
      South Carolina, USA.
FAU - Almazan, Erik
AU  - Almazan E
AD  - Division of Gastroenterology, Johns Hopkins University School of Medicine, 
      Baltimore, Maryland, USA.
FAU - Vosoughi, Kia
AU  - Vosoughi K
AD  - Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
FAU - Ichkhanian, Yervant
AU  - Ichkhanian Y
AD  - Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
FAU - Al-Hawary, Mahmoud
AU  - Al-Hawary M
AD  - Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
FAU - Chang, Andrew C
AU  - Chang AC
AD  - Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
FAU - Chen, Joan W
AU  - Chen JW
AD  - Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
FAU - Korsnes, Sheryl
AU  - Korsnes S
AD  - Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
FAU - Elmunzer, B Joseph
AU  - Elmunzer BJ
AD  - Division of Gastroenterology, Medical University of South Carolina, Charleston, 
      South Carolina, USA.
FAU - Khashab, Mouen A
AU  - Khashab MA
AD  - Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
FAU - Law, Ryan
AU  - Law R
AD  - Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
LA  - eng
GR  - P30 DK123704/DK/NIDDK NIH HHS/United States
PT  - Journal Article
DEP - 20200603
PL  - United States
TA  - Gastrointest Endosc
JT  - Gastrointestinal endoscopy
JID - 0010505
SB  - IM
CIN - Gastrointest Endosc. 2021 Jan;93(1):107-109. PMID: 33353610
MH  - *Esophageal Achalasia/surgery
MH  - Esophageal Sphincter, Lower/surgery
MH  - Humans
MH  - *Myotomy
MH  - *Natural Orifice Endoscopic Surgery
MH  - Retrospective Studies
MH  - Treatment Outcome
PMC - PMC8783294
MID - NIHMS1769672
EDAT- 2020/06/07 06:00
MHDA- 2021/06/01 06:00
PMCR- 2022/01/22
CRDT- 2020/06/07 06:00
PHST- 2020/04/06 00:00 [received]
PHST- 2020/05/08 00:00 [accepted]
PHST- 2020/06/07 06:00 [pubmed]
PHST- 2021/06/01 06:00 [medline]
PHST- 2020/06/07 06:00 [entrez]
PHST- 2022/01/22 00:00 [pmc-release]
AID - S0016-5107(20)34396-0 [pii]
AID - 10.1016/j.gie.2020.05.046 [doi]
PST - ppublish
SO  - Gastrointest Endosc. 2021 Jan;93(1):102-106. doi: 10.1016/j.gie.2020.05.046. Epub 
      2020 Jun 3.