Journal article
Clinical Impact of Routine Esophagram after Peroral Endoscopic Myotomy: A Systematic Review and Meta-analysis
Gastrointestinal endoscopy, Vol.103(3), pp.451-458000
03/2026
DOI: 10.1016/j.gie.2025.09.053
PMID: 41076026
Abstract
Peroral endoscopic myotomy (POEM) hasf become a major treatment for esophageal motility disorders. Early routine post-POEM esophagram is frequently performed to assess for adverse events (AEs), although the clinical benefit remains questionable. We conduct a systematic review and meta-analysis to evaluate the clinical impact of routine esophagram after POEM in asymptomatic patients.
PubMed was searched from inception to November 2024. The primary outcome was to evaluate the incidence of intramural and extramural esophageal leaks after POEM. Secondary outcomes included radiographic findings on routine esophagram after POEM and the rate in which radiographic findings resulted in a change in management. A random-effects model was used and outcomes were represented as pooled rates, along with 95% confidence intervals (CI).
Fourteen studies with 2153 patients were included. Most patients (mean age ranged from 39.4 to 59.3 years) had achalasia (90.6%) with mean baseline Eckardt score ranging between 3.0-12. Patients underwent routine esophagram within 24-72 hours after POEM. The pooled rates of intramural and extramural esophageal leaks were 2.3% (95% CI: 0.8-6.1; I
=79.4) and 1.4% (95% CI: 0.8-2.5; I
=81.6), respectively. Pneumoperitoneum and pneumomediastinum were the two most common findings on imaging, with pooled rates of 42.0% (95% CI: 26.5-59.2) and 33.7% (95% CI: 12.4-64.6), respectively. Collectively, the frequency in which routine imaging findings resulted in a change in management was 3.4% (95%CI: 1.7-6.8; I
=81.6).
Esophageal leakage is a very uncommon AE after POEM. Routine esophagram rarely impacted immediate post-procedural care in asymptomatic patients. Selective imaging may result in higher diagnostic yield, improved cost-efficiency, and mitigate the risk of unwarranted additional testing due to incidental radiographic findings.
Details
- Title: Subtitle
- Clinical Impact of Routine Esophagram after Peroral Endoscopic Myotomy: A Systematic Review and Meta-analysis
- Creators
- Ernesto Robalino Gonzaga - Florida Hospital Medical GroupSaurabh Chandan - AdventHealth OrlandoAbdullah Abbasi - AdventHealth OrlandoMohammed S Abdul - Gastroenterology, AdventHealth Medical Group, Orlando, FL, USASagar Pathak - AdventHealth OrlandoSmit S Deliwala - Emory UniversityShahab R Khan - Brigham and Women's HospitalDeepanshu Jain - AdventHealth OrlandoNatalie Cosgrove - AdventHealth OrlandoMustafa A Arain - AdventHealth OrlandoKambiz K Kadkhodayan - AdventHealth OrlandoMaham Hayat - AdventHealth OrlandoMuhammad K Hasan - AdventHealth OrlandoDennis Yang - AdventHealth Orlando
- Resource Type
- Journal article
- Publication Details
- Gastrointestinal endoscopy, Vol.103(3), pp.451-458000
- DOI
- 10.1016/j.gie.2025.09.053
- PMID
- 41076026
- NLM abbreviation
- Gastrointest Endosc
- ISSN
- 1097-6779
- eISSN
- 1097-6779
- Publisher
- MOSBY-ELSEVIER
- Grant note
- The 3D-MatrixBoston ScientificOlympus
The following authors disclosed financial relationships: D. Yang: Consultant for Olympus, Fujifilm, Boston Scienti-fic, Medtronic, 3D-Matrix, Microtech, and Neptune Medi-cal; and research grants from Microtech, 3D-Matrix, and Boston Scientific. M. K. Hasan: Consultant for Boston Scientific, Olympus, and Microtech. N. Cosgrove: Consul-tant for Boston Scientific and Olympus. M. A. Arain: Consultant for Boston Scientific, Olympus, and Cook Med-ical. All other authors disclosed no financial relationships.
- Language
- English
- Electronic publication date
- 10/09/2025
- Date published
- 03/2026
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985014898002771
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