Abstract：
BACKGROUND: The routine use of post-operative esophogram has come under evaluation for multiple upper GI surgeries such as with bariatric surgery and gastric resections. A major complication following Per Oral Endoscopic Myotomy (POEM) is a leak from the myotomy site. A post-operative contrast esophogram is often utilized to evaluate the presence of a leak, however it is not a standardized care practice for all patients. Presently it is selectively performed depending on physician assessment intra-operatively. This project will evaluate the necessity of post-operative contrast esophogram following POEM.
METHODS: We retrospectively reviewed 277 patients diagnosed with achalasia who underwent POEM by two surgeons from 2011 to 2022. 173 patients met the inclusion criteria. A post-operative esophogram was used for the evaluation of a leak. Post-operative esophagram were selectively performed on day 1 following surgery using a water-soluble material. Data was evaluated using Stata.
RESULTS: There were 3 detected leaks in the group that underwent esophagrams compared to the non-esophagram group in the early post-operative period. The overall complication rate was 5.5% in the non-esophagram versus 7.9% in the esophagram group. Length of stay was 1.48 days in the non-UGI vs 1.76 days in the esophagram group. Readmission rate was 10.9% in non-esophagram versus 8.7% in esophagram group.
CONCLUSIONS: There was no statistically significant difference in outcomes in patients undergoing POEM who received post-operative esophagram verses patients who did not receive post-operative esophagram. The routine use of a contrast esophogram to detect a leak following POEM may not be justified. This study suggests that esophagrams should be performed depending on the clinical signs/symptoms post-operatively that would warrant imaging and intervention.
METHODS: We retrospectively reviewed 277 patients diagnosed with achalasia who underwent POEM by two surgeons from 2011 to 2022. 173 patients met the inclusion criteria. A post-operative esophogram was used for the evaluation of a leak. Post-operative esophagram were selectively performed on day 1 following surgery using a water-soluble material. Data was evaluated using Stata.
RESULTS: There were 3 detected leaks in the group that underwent esophagrams compared to the non-esophagram group in the early post-operative period. The overall complication rate was 5.5% in the non-esophagram versus 7.9% in the esophagram group. Length of stay was 1.48 days in the non-UGI vs 1.76 days in the esophagram group. Readmission rate was 10.9% in non-esophagram versus 8.7% in esophagram group.
CONCLUSIONS: There was no statistically significant difference in outcomes in patients undergoing POEM who received post-operative esophagram verses patients who did not receive post-operative esophagram. The routine use of a contrast esophogram to detect a leak following POEM may not be justified. This study suggests that esophagrams should be performed depending on the clinical signs/symptoms post-operatively that would warrant imaging and intervention.
摘要：
背景：术后食管造影的常规应用已被评估用于多种上消化道手术，如减重手术和胃切除术。每次经口内窥镜肌切开术（POEM）后的主要并发症是肌切开术部位的泄漏。术后食管造影通常用于评估泄漏的存在，然而，这并不是所有患者的标准化护理实践。目前,根据医师术中评估选择性地进行。本项目将评估POEM术后食管造影的必要性。
方法：我们回顾性回顾了2011年至2022年由两名外科医生诊断为贲门失弛缓症的277例患者。173例患者符合纳入标准。术后食管造影用于评估泄漏。在手术后第1天使用水溶性材料选择性地进行术后食道图。使用Stata评估数据。
结果：在术后早期，与非食道组相比，在接受食道组发现了3例漏气。非食道组的总并发症发生率为5.5％，而食道组为7.9％。非UGI组的住院时间为1.48天，食管镜组为1.76天。非食道组的再入院率为10.9％，而食道组为8.7％。
结论：接受POEM治疗的患者接受术后食道检查的患者与未接受术后食道检查的患者的预后差异无统计学意义。在POEM之后常规使用食管造影来检测泄漏可能是不合理的。这项研究表明，应根据术后的临床体征/症状进行食道检查，以进行影像学检查和干预。
方法：我们回顾性回顾了2011年至2022年由两名外科医生诊断为贲门失弛缓症的277例患者。173例患者符合纳入标准。术后食管造影用于评估泄漏。在手术后第1天使用水溶性材料选择性地进行术后食道图。使用Stata评估数据。
结果：在术后早期，与非食道组相比，在接受食道组发现了3例漏气。非食道组的总并发症发生率为5.5％，而食道组为7.9％。非UGI组的住院时间为1.48天，食管镜组为1.76天。非食道组的再入院率为10.9％，而食道组为8.7％。
结论：接受POEM治疗的患者接受术后食道检查的患者与未接受术后食道检查的患者的预后差异无统计学意义。在POEM之后常规使用食管造影来检测泄漏可能是不合理的。这项研究表明，应根据术后的临床体征/症状进行食道检查，以进行影像学检查和干预。
