Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
Division of Gastroenterology, UT Southwestern, Dallas, Texas, USA.
Gastrointest Endosc. 2021 Jan;93(1):102-106. doi: 10.1016/j.gie.2020.05.046. Epub 2020 Jun 3.
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.
术后第 1 天（POD1）食管造影是否会影响临床治疗或可靠地识别与经口内镜肌切开术（POEM）相关的重大不良事件（AE）尚不清楚。因此，我们旨在将最具临床相关性的食管造影结果与 POEM 后的术后结果相关联。
回顾性分析 2014 年至 2018 年间在 3 家研究机构中接受 POEM 治疗的患者。根据术后第 1 天的食管造影结果（如食管裂孔或漏）评估患者的预后。
共纳入 170 例 POEM 后对比食管造影（139 例基于透视检查，31 例基于 CT 检查），在 POD1 进行。大多数食管造影（n=98）显示异常发现，但只有 5 例显示食管漏或裂孔。4 例患者确诊术后漏或裂孔。在 2 例患者中，POD1 食管造影正确识别出漏或裂孔，但在另外 2 例患者中，最初的食管造影为阴性，在临床恶化前未识别出 AEs。1 例患者的食管造影显示假阳性漏和裂孔，导致内镜检查无异常。
尽管 POEM 后 AE 发生率较低，但术后第 1 天的随访食管造影经常显示预期的、无明显异常的术后发现，偶尔未能诊断出严重的 AE。这导致食管造影与临床和内镜发现之间的准确性存在陷阱。仅依靠食管造影进行 POEM 后临床决策可能导致不必要的额外检查或漏诊 AE。
