Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA.
Department of Radiology, University of Florida, Gainesville, Florida, USA.
Gastrointest Endosc. 2016 Sep;84(3):408-15. doi: 10.1016/j.gie.2016.02.022. Epub 2016 Feb 22.
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 evaluation after POEM and for reporting the full spectrum of radiographic findings and subsequent interventions.
This was a single-center prospective study of consecutive patients treated with POEM evaluated with CT esophagram.
Eighty-four consecutive patients who had POEM performed underwent CT esophagrams. The 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 and/or stomach (13.1%), pericardial effusion (2.4%), and pneumopericardium (2.4%). Five patients required intervention based on CT findings. In 1 patient, a leak was detected on CT esophagram before any clinical manifestation, facilitating prompt intervention and avoiding potential serious outcomes. Four patients were diagnosed with pneumonia and were treated with antibiotics. There was frequent postprocedural atelectasis, which prompted the introduction of routine incentive spirometry in all postoperative POEM cases.
CT esophagram is a simple and accessible imaging test for routine postoperative 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 postprocedure management. (
NCT01832779.).
经口内镜下肌切开术（POEM）是一种有发生严重不良事件风险的手术。术后通常会进行影像学检查，但目前尚没有关于最佳影像学检查方案的共识。我们描述了一种新的简单 CT 食管造影方案，用于 POEM 术后评估，并报告所有射线照相表现和随后的干预措施。
这是一项连续接受 POEM 治疗的患者的单中心前瞻性研究，采用 CT 食管造影进行评估。
84 例连续接受 POEM 治疗的患者进行了 CT 食管造影。最常见的发现是纵隔积气（85.7%）、气腹（66.7%）、皮下气肿（52.4%）和胸腔积液（46.4%）。其他发现包括腹膜后积气（38.1%）、气胸（19%）、肺不张（14.3%）、食管和/或胃壁内积气（13.1%）、心包积液（2.4%）和心包积气（2.4%）。5 例患者根据 CT 发现需要进行干预。1 例患者在出现任何临床表现之前，CT 食管造影上发现漏诊，这有助于及时干预，避免潜在的严重后果。4 例患者被诊断为肺炎，接受了抗生素治疗。术后经常发生肺不张，这促使我们在所有 POEM 术后患者中常规引入激励式呼吸训练。
CT 食管造影是 POEM 术后常规评估的一种简单且易于获得的影像学检查方法。使用这种成像方式可以预期并显示出许多明显的术后射线照相表现。虽然这些表现大多数可能不需要干预，但有些具有潜在意义，早期识别可能有助于改变术后管理。（临床试验注册号：NCT01832779）。
