Post-POEM Contrast-Enhanced Swallow Study: Is It Always Necessary?

Autor: Szydlo Shein G; Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel., Elazary R; Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Marom G; Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Fishman Y; Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel., Abu Gazala M; Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Brodie R; Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel., Jacob H; Department of Gastroenterology, Hadassah Hebrew University Medical Center, Jerusalem, Israel., Benson AA; Department of Gastroenterology, Hadassah Hebrew University Medical Center, Jerusalem, Israel., Rivkind A; Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel., Pikarsky AJ; Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Mintz Y; Department of General Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel. ymintz@hadassah.org.il.; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. ymintz@hadassah.org.il.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2023 May; Vol. 27 (5), pp. 878-886. Date of Electronic Publication: 2023 Jan 31.
DOI: 10.1007/s11605-023-05605-z
Abstrakt: Background: Peroral endoscopic myotomy (POEM) is rapidly becoming the procedure of choice for treating esophageal achalasia. In most centers, contrast-enhanced swallow studies (CESS) are routinely performed postoperatively to confirm mucosal integrity. The aim of this study was to determine the necessity of performing these studies routinely after POEM.
Methods: A retrospective review of a prospectively maintained database of patients who underwent POEM between December 2012 and November 2020 was performed. All patients underwent a CESS on the first postoperative day. Medical records including vital signs, complete blood count, and POD-1 CESS were evaluated.
Results: One hundred thirty-four consecutive patients were included in the study. Sixty-nine (51.49%) CESS showed abnormal findings; while most findings did not change the postoperative course, five (7.2%) demonstrated tunnel leaks, which did alter the overall management. Screening patients for fever, tachycardia, or leukocytosis on POD-1 had a 100% sensitivity and a 62% specificity for finding a clinically significant complication on CESS.
Conclusions: The study findings suggest that performing routine contrast-enhanced swallow studies on all patients is not necessary following POEM, as leaks can be screened for by clinical or laboratory abnormalities. Herein, we propose an algorithm based on objective measurable findings for the selection of patients who should undergo CESS.
(© 2023. The Society for Surgery of the Alimentary Tract.)
Databáze: MEDLINE
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