Abstract
ROUTINE ESOPHAGRAM TO DETECT EARLY ESOPHAGEAL LEAKAGE AFTER PER-ORAL ENDOSCOPIC MYOTOMY (POEM): IS IT CLINICALLY INDICATED?
Gastrointestinal endoscopy, Vol.101(5 Supplement), pp.S478-S478
05/2025
DOI: 10.1016/j.gie.2025.03.1246
Abstract
Background
Per-oral endoscopic myotomy (POEM) has become widely accepted for the management of achalasia. Yet, there is a lack of evidence and standardization on the immediate post-procedural care of these patients. While an esophagram is commonly performed to evaluate for leaks prior to advancement of diet, the clinical benefit of this practice is questionable. We performed a systematic review and meta-analysis to evaluate the role of routine esophagram in the immediate post-procedural care of patients undergoing POEM.
Methods
Multiple databases were searched through November 2024 for relevant studies reporting on the routine use of esophagram for post-operative imaging after POEM. Studies were included if they reported outcomes of post- procedural esophagram after POEM and provided quantitative data on adverse events, specifically contained leaks (confined within the esophageal wall), extramural leaks (leaks extending beyond the esophageal wall and into surrounding tissue), and esophageal perforations. Pooled rates and risk ratios (RR) with 95% confidence intervals (CI) were assessed using a random-effects model. Heterogeneity was assessed using I2 statistics.
Results
A total of 13 studies with 2,153 patients (median age of 53 years, 53% men) were included. The pooled proportion of cases with no leaks on routine esophagram was 97.1% (95% CI: 93.9-98.7, I274.5). The pooled rates of either contained and extramural leaks identified on imaging were low: 2.3% (95% CI: 0.8-6.1, I279.4) and 1.4% (95% CI: 0.8-2.5, I20), respectively. Additional radiographic findings on routine imaging are summarized in Table 1.
Collectively, the frequency in which routine imaging findings resulted in a change in management was 3.4% (95% CI: 1.7-6.8, I281.6).
Conclusions
This study demonstrates that the incidence of leaks identified on routine esophagram after POEM was very low. Routine post-procedural imaging may not be cost-effective and most radiographic findings are clinically inconsequential. Clinically significant findings on post-procedural imaging are often accompanied by other signs and symptoms. Overall, this data support selective post-POEM imaging, reserved to those with a high index of suspicion of post-procedure adverse events.
Details
- Title: Subtitle
- ROUTINE ESOPHAGRAM TO DETECT EARLY ESOPHAGEAL LEAKAGE AFTER PER-ORAL ENDOSCOPIC MYOTOMY (POEM): IS IT CLINICALLY INDICATED?
- Creators
- Ernesto Robalino GonzagaAbdullah AbbasiSaurabh ChandanAbdul S. MohammedSagar PathakDeepanshu JainNatalie D. CosgroveMustafa A. ArainKambiz S. KadkhodayanMaham HayatMuhammad K. HasanDennis Yang
- Resource Type
- Abstract
- Publication Details
- Gastrointestinal endoscopy, Vol.101(5 Supplement), pp.S478-S478
- DOI
- 10.1016/j.gie.2025.03.1246
- ISSN
- 0016-5107
- Language
- English
- Date published
- 05/2025
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984843740302771
Metrics
1 Record Views